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New York 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
$32.22 / $42.74 / $104.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.88 / $111.47 / $691.23
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.73 / $74.93 / $611.59
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$31.66 / $45.02 / $101.80
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.59 / $53.59 / $73.69
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$27.55 / $27.55 / $27.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.05 / $73.27 / $167.52
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$26.69 / $34.90 / $77.08
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$29.35 / $38.11 / $94.89
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.07 / $47.17 / $93.24
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$37.07 / $37.07 / $37.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.93 / $101.70 / $214.94
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.07 / $43.46 / $101.76
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$30.86 / $54.53 / $113.18
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.78 / $90.99 / $138.05
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$31.20 / $43.33 / $68.64
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$34.52 / $47.85 / $83.64
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.31 / $62.75 / $123.15
Excellus BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.23 / $33.04 / $63.50
Excellus BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$18.79 / $37.15 / $61.92
Fidelis
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.23 / $68.23 / $68.23
Fidelis
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.63 / $28.63 / $34.59
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.02 / $73.38 / $74.45
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.61 / $44.56 / $79.67
MVP Health Care
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$37.07 / $37.07 / $37.07
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.79 / $101.70 / $218.15
MVP Health Care
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$31.82 / $44.08 / $100.09
MVP Health Care
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$33.31 / $51.93 / $107.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.67 / $76.62 / $160.52
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$26.47 / $35.72 / $79.17
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$29.14 / $40.77 / $83.66
Univera
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$34.94 / $34.94 / $97.91
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.38 / $86.01 / $190.16
Univera
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.23 / $42.76 / $90.73
Univera
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$31.55 / $43.25 / $95.61