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Minnesota 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
$426.58 / $426.58 / $1,445.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,137.96 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$371.54 / $562.34 / $2,089.30
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,230.27 / $1,737.80 / $3,311.31
BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$316.23 / $371.54 / $371.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.95 / $4,365.16 / $6,606.93
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$691.83 / $1,000.00 / $1,513.56
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$2,344.23 / $3,467.37 / $5,128.61
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$1,096.48 / $1,548.82 / $3,715.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.03 / $3,630.78 / $5,754.40
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$645.65 / $812.83 / $1,318.26
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$2,238.72 / $2,818.38 / $4,570.88
Health Partners
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$1,202.26 / $1,479.11 / $2,951.21
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.03 / $2,884.03 / $4,466.84
Health Partners
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$645.65 / $645.65 / $1,000.00
Health Partners
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$2,238.72 / $2,238.72 / $3,467.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $4,365.16 / $9,332.54
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$524.81 / $1,071.52 / $2,344.23
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,659.59 / $2,951.21 / $8,912.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $3,715.35 / $6,456.54
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$478.63 / $794.33 / $1,412.54
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,698.24 / $2,951.21 / $5,011.87