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Washington rates for HCPCS 77301

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

Facilitymedian $832 · 10th–90th $407$3,6310%10%10th90th$832Professionalmedian $1,862 · 10th–90th $427$5,3700%5%10th90th$1,862$50.0$200.0$1.0K$5.0K

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
$407.38 / $794.33 / $1,412.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $2,511.89 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$371.54 / $776.25 / $2,041.74
Aetna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$1,230.27 / $1,905.46 / $5,248.07
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,621.81 / $3,090.30
Ambetter
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$363.08 / $588.84 / $851.14
Asuris Northwest Health
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$2,454.71 / $2,454.71 / $2,454.71
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,511.89 / $3,890.45 / $5,754.40
Asuris Northwest Health
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$562.34 / $870.96 / $1,318.26
Asuris Northwest Health
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$1,905.46 / $3,019.95 / $4,570.88
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,344.23 / $3,630.78 / $6,025.60
Cigna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$489.78 / $794.33 / $1,258.93
Cigna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$1,905.46 / $2,818.38 / $4,677.35
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$537.03 / $954.99 / $6,025.60
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,398.83 / $4,168.69 / $5,495.41
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$537.03 / $891.25 / $1,148.15
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$1,905.46 / $3,235.94 / $4,365.16
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $33.11
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $954.99 / $3,090.30
Premera BCBS
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$549.54 / $549.54 / $575.44
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,511.89 / $3,890.45 / $5,248.07
Premera BCBS
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$575.44 / $891.25 / $1,202.26
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$1,949.84 / $3,019.95 / $4,073.80
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$2,454.71 / $2,454.71 / $2,454.71
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,511.89 / $3,890.45 / $5,754.40
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$588.84 / $870.96 / $1,318.26
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$2,041.74 / $2,951.21 / $4,466.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $2,454.71 / $4,786.30
United
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$323.59 / $524.81 / $1,071.52
United
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$1,380.38 / $1,949.84 / $3,630.78
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,344.23 / $2,754.23 / $4,466.84
Wellpoint
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$467.74 / $575.44 / $870.96
Wellpoint
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$1,862.09 / $2,187.76 / $3,548.13