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Illinois 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
$389.05 / $691.83 / $1,318.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,344.23 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$371.54 / $645.65 / $1,737.80
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,174.90 / $1,737.80 / $3,388.44
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,862.09 / $2,754.23
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$316.23 / $426.58 / $588.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $1,905.46 / $4,073.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,511.89 / $3,715.35
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$380.19 / $549.54 / $812.83
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,288.25 / $1,949.84 / $3,019.95
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,951.21 / $7,943.28
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$446.68 / $676.08 / $2,691.53
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,412.54 / $2,238.72 / $5,128.61
Hally Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,238.72 / $2,398.83
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$512.86 / $524.81 / $549.54
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,659.59 / $1,698.24 / $1,862.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $33.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,511.89 / $3,467.37
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$407.38 / $524.81 / $758.58
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,513.56 / $1,949.84 / $2,754.23