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Kansas rates for HCPCS 77300

Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$36.57 / $39.09 / $72.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.40 / $71.70 / $320.88
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$31.28 / $36.57 / $92.57
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$31.30 / $35.14 / $45.02
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.49 / $48.49 / $72.73
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$24.44 / $38.18 / $51.88
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$24.78 / $24.78 / $24.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.58 / $114.58 / $114.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.54 / $87.09 / $171.00
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$27.72 / $44.17 / $94.00
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$31.45 / $49.74 / $77.00
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$76.59 / $76.59 / $76.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.84 / $93.40 / $468.00
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.11 / $41.55 / $378.10
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$34.29 / $56.55 / $378.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.01 / $92.92 / $129.22
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.06 / $36.85 / $65.87
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$32.89 / $46.75 / $64.63