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Utah rates for HCPCS 77300

Basic Radiation Dosimetry Calculation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$34.59 / $34.59 / $34.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.34 / $313.70 / $1,805.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.59 / $186.93 / $684.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$35.34 / $44.02 / $940.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.88 / $90.56 / $121.28
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.02 / $42.14 / $60.77
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$38.85 / $47.69 / $61.67
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.45 / $38.81 / $66.38
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$230.90 / $230.90 / $230.90
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.15 / $121.23 / $128.87
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.09 / $60.89 / $67.54
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$50.07 / $57.71 / $62.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.84 / $84.81 / $112.80
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.56 / $41.95 / $55.37
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$34.29 / $46.37 / $61.23