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Nebraska 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
$859.00 / $2,292.09 / $3,359.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,709.16 / $4,100.00 / $11,080.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$402.56 / $906.62 / $2,063.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,306.59 / $1,306.59 / $8,751.70
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,450.78 / $3,450.78 / $3,450.78
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$407.38 / $954.44 / $954.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,176.82 / $3,395.67 / $3,480.57
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$741.69 / $792.77 / $812.60
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$2,435.13 / $2,602.90 / $2,667.96
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$2,339.52 / $2,339.52 / $2,339.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,186.00 / $4,275.53 / $5,455.11
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$659.00 / $975.83 / $1,219.79
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$2,527.00 / $3,277.34 / $4,235.32
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$886.59 / $1,924.04 / $1,924.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,320.88 / $3,481.32 / $13,450.23
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$495.83 / $805.72 / $2,845.07
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,783.73 / $2,731.85 / $9,015.64
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$1,292.23 / $1,329.87 / $2,339.52
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,660.00 / $3,849.40 / $4,994.30
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.88 / $1,656.60 / $3,378.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,320.88 / $3,589.24 / $4,463.22
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$495.83 / $803.11 / $1,032.98
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,783.73 / $2,675.60 / $3,430.25