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Utah 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
$79.43 / $79.43 / $79.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $151.36 / $323.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $194.98 / $275.42
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $54.95 / $269.15
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$616.60 / $616.60 / $616.60
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $257.04 / $295.12
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $263.03 / $323.59
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $138.04 / $275.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $190.55 / $263.03