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South Carolina 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
$26.92 / $35.48 / $51.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $102.33 / $758.58
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.90 / $162.18 / $630.96
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$25.70 / $34.67 / $61.66
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $53.70 / $91.20
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.12 / $33.11 / $46.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $89.13 / $162.18
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.11 / $45.71 / $69.18
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$33.11 / $34.67 / $81.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $93.33 / $134.90
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.11 / $44.67 / $60.26
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$34.67 / $48.98 / $70.79
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89
Medcost
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$60.26 / $60.26 / $60.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $77.62 / $125.89
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.84 / $37.15 / $61.66
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$30.90 / $38.02 / $67.61