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Florida 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
$271.89 / $358.83 / $1,387.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,198.49 / $1,774.22 / $3,099.63
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$271.89 / $405.68 / $1,128.59
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$926.59 / $1,297.73 / $2,268.77
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,373.91 / $1,498.19 / $2,814.97
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$329.46 / $489.31 / $668.36
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$477.29 / $477.29 / $477.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,408.61 / $2,337.63 / $3,428.34
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$329.73 / $514.47 / $751.19
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,111.96 / $1,819.48 / $2,746.73
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.17 / $1,290.29 / $2,265.57
Florida Blue
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$285.43 / $305.82 / $489.62
Florida Blue
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$916.74 / $982.22 / $1,727.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.48 / $1,428.45 / $2,397.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,494.89 / $2,046.56 / $3,422.62
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$323.11 / $429.47 / $785.93
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,150.42 / $1,583.05 / $2,633.63
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,198.70 / $1,198.70 / $1,198.70
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$270.44 / $270.44 / $270.44
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$928.26 / $928.26 / $928.26