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North Carolina 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
$411.57 / $442.74 / $654.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,747.32 / $1,889.42 / $5,133.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$353.64 / $411.58 / $1,133.85
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,267.58 / $1,335.76 / $2,474.75
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,329.38 / $1,417.67 / $2,326.41
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$317.56 / $555.51 / $732.30
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$553.22 / $808.32 / $1,054.80
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,789.21 / $3,280.22 / $4,226.45
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
$1,697.51 / $2,879.41 / $5,114.87
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$405.69 / $627.64 / $1,125.53
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,308.73 / $2,302.59 / $3,956.37
Medcost
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$577.35 / $674.00 / $1,121.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.00 / $1,930.00 / $2,452.00
Medcost
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$2,442.27 / $2,442.27 / $2,442.27
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$592.75 / $2,052.96 / $3,710.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,824.76 / $2,564.48 / $5,028.14
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$391.16 / $589.96 / $1,136.90
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,346.59 / $1,974.53 / $3,844.42
Wellcare
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$985.21 / $985.21 / $2,118.79
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,988.24 / $13,988.24 / $15,609.38
Wellcare
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$2,958.87 / $2,958.87 / $3,439.95
Wellcare
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$9,015.64 / $9,015.64 / $12,169.43