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Tennessee 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
$31.00 / $43.09 / $168.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.41 / $70.05 / $650.69
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$27.07 / $36.95 / $427.25
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$28.93 / $35.34 / $49.07
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.15 / $61.38 / $105.93
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.88 / $33.49 / $55.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.04 / $83.72 / $127.52
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.39 / $43.43 / $71.31
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$28.42 / $46.80 / $73.00
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$51.21 / $51.21 / $51.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.21 / $96.37 / $152.83
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$31.11 / $48.05 / $73.81
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$31.04 / $50.93 / $83.62
Lucent Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$85.90 / $170.00 / $170.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.00 / $468.11 / $560.92
Lucent Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$378.10 / $378.10 / $378.10
Lucent Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$378.10 / $378.10 / $378.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.74 / $84.91 / $166.70
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.32 / $36.92 / $83.59
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$31.78 / $42.41 / $80.28