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New Hampshire rates for HCPCS 77306

Teletherapy isodose plan; simple (1 or 2 unmodified ports directed to a single area of interest), includes basic dosimetry calculation(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$114.82 / $114.82 / $114.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $169.82 / $371.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $213.80 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $331.13 / $457.09
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $309.03 / $467.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $199.53 / $512.86
Well Sense
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$54.95 / $54.95 / $54.95