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Michigan rates for HCPCS 77301

Ntsty Modul Radthx Pln Dose-Vol Histos

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$493.89 / $493.90 / $622.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,889.42 / $2,095.90 / $3,163.96
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$347.37 / $493.89 / $1,003.14
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,542.03 / $1,649.83 / $2,474.75
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,666.75 / $1,793.62 / $1,972.98
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$340.35 / $417.81 / $600.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$596.16 / $2,677.02 / $3,015.17
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$637.62 / $637.62 / $637.62
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$2,376.21 / $2,376.21 / $2,376.21
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$592.85 / $1,801.23 / $2,784.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,695.98 / $2,333.57 / $4,222.62
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$355.42 / $550.55 / $936.70
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,333.34 / $1,873.68 / $3,544.96
Health Alliance Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$314.37 / $493.89 / $502.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,555.77 / $2,068.55 / $2,773.39
Health Alliance Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$314.37 / $493.89 / $906.94
Health Alliance Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,241.41 / $1,574.66 / $2,338.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.05 / $1,396.55 / $2,075.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,747.29 / $2,225.77 / $3,060.44
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$363.86 / $469.37 / $657.62
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,425.21 / $1,759.68 / $2,382.21