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Missouri 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
$31.96 / $39.28 / $72.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.01 / $69.63 / $1,500.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.73 / $95.31 / $652.52
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$26.84 / $35.34 / $197.51
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.22 / $48.49 / $101.30
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.19 / $38.07 / $49.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.03 / $77.45 / $137.96
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$32.13 / $39.52 / $62.07
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$29.90 / $37.86 / $75.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.68 / $93.75 / $139.61
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.76 / $44.67 / $69.95
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$32.02 / $49.50 / $69.65
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$76.59 / $170.00 / $170.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.40 / $91.08 / $468.00
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$31.67 / $40.28 / $378.10
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$33.21 / $46.55 / $378.10
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.50 / $116.50 / $116.50
Qualchoice
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$59.72 / $59.72 / $59.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.00 / $84.14 / $137.33
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$31.36 / $40.21 / $68.91
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$29.14 / $42.67 / $68.42