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Michigan rates for HCPCS 77301

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

Facilitymedian $501 · 10th–90th $490$6170%20%40%10th90th$501Professionalmedian $1,445 · 10th–90th $407$2,8180%5%10%10th90th$1,445$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$489.78 / $501.19 / $616.60
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,089.30 / $5,011.87
Aetna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$354.81 / $501.19 / $1,202.26
Aetna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$1,258.93 / $1,621.81 / $2,818.38
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,778.28 / $1,778.28 / $1,778.28
Ambetter
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$346.74 / $416.87 / $616.60
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $2,818.38 / $3,019.95
BCBS
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$630.96 / $630.96 / $630.96
BCBS
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$2,398.83 / $2,398.83 / $2,398.83
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $1,659.59 / $3,801.89
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,344.23 / $3,981.07
Cigna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$354.81 / $489.78 / $794.33
Cigna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$1,318.26 / $1,737.80 / $3,388.44
Health Alliance Plan
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$489.78 / $501.19 / $912.01
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,621.81 / $2,137.96 / $3,801.89
Health Alliance Plan
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$346.74 / $489.78 / $1,000.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$1,258.93 / $1,698.24 / $3,019.95
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,454.71 / $3,981.07
Priority Health
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$354.81 / $616.60 / $794.33
Priority Health
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$1,318.26 / $1,737.80 / $3,548.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,621.81 / $2,238.72 / $3,090.30
United
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$354.81 / $478.63 / $676.08
United
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$1,348.96 / $1,778.28 / $2,818.38