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Wyoming 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
$31.87 / $31.87 / $32.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.14 / $65.93 / $1,440.94
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$32.42 / $98.58 / $98.58
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$33.17 / $33.17 / $33.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.00 / $136.00 / $245.00
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$122.00 / $122.00 / $122.00
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$123.00 / $123.00 / $123.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.68 / $99.34 / $236.94
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.14 / $50.98 / $117.12
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$40.54 / $48.14 / $119.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.49 / $112.80 / $209.00
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$36.95 / $55.79 / $113.10
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$48.41 / $66.18 / $113.30