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Delaware rates for HCPCS 77301

Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$379.93 / $555.88 / $976.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,571.74 / $1,889.42 / $2,319.19
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$347.37 / $347.57 / $428.23
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,203.48 / $1,542.03 / $1,542.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,491.53 / $2,220.96 / $2,670.97
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$333.18 / $466.99 / $650.09
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,158.34 / $1,758.66 / $2,115.36
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$430.28 / $440.21 / $776.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,442.74 / $2,003.76 / $4,368.87
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$320.43 / $456.33 / $946.31
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,279.06 / $1,490.29 / $3,349.08