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West Virginia 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
$25.82 / $28.40 / $28.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.29 / $62.20 / $75.63
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$27.07 / $64.09 / $420.53
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$23.47 / $32.59 / $44.02
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.31 / $71.48 / $138.41
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
$71.64 / $83.58 / $354.38
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.37 / $43.16 / $154.34
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$34.65 / $44.16 / $160.60
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.24 / $50.77 / $75.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.49 / $79.86 / $161.65
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.10 / $36.43 / $65.37
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$22.39 / $46.19 / $93.06