go back

Wyoming 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
$409.41 / $409.41 / $418.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,794.29 / $1,860.59 / $9,969.37
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$416.68 / $416.68 / $423.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,384.88 / $1,438.95 / $8,581.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,798.00 / $6,814.00 / $6,814.00
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$863.00 / $1,549.00 / $1,549.00
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$2,935.00 / $5,265.00 / $5,265.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,529.51 / $2,529.96 / $5,375.45
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$541.19 / $541.65 / $1,075.65
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,988.32 / $2,090.48 / $5,302.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,480.91 / $3,240.60 / $6,587.90
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$475.12 / $719.39 / $1,298.13
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,988.63 / $2,731.85 / $5,353.68