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Wisconsin rates for HCPCS 77307

Teletherapy isodose plan; complex (multiple treatment areas, tangential ports, the use of wedges, blocking, rotational beam, or special beam considerations), includes basic dosimetry calculation(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$229.09 / $229.09 / $323.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $295.12 / $741.31
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$131.83 / $218.78 / $537.03
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$109.65 / $144.54 / $295.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $426.58 / $1,513.56
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$147.91 / $229.09 / $831.76
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$128.82 / $199.53 / $691.83
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$407.38 / $467.74 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $954.99 / $1,479.11
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$223.87 / $489.78 / $794.33
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$199.53 / $457.09 / $707.95
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $676.08 / $812.83
DeanCare
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$309.03 / $363.08 / $436.52
DeanCare
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$275.42 / $323.59 / $389.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $575.44 / $1,778.28
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$169.82 / $309.03 / $954.99
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$147.91 / $269.15 / $831.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $389.05
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $691.83 / $1,258.93
Quartz
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$363.08 / $363.08 / $954.99
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $1,412.54 / $1,778.28
Quartz
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$223.87 / $758.58 / $954.99
Quartz
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$199.53 / $645.65 / $831.76
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,778.28 / $2,137.96
Security Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$457.09 / $512.86 / $707.95
Security Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$416.87 / $457.09 / $616.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $537.03 / $1,258.93
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$158.49 / $288.40 / $676.08
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$138.04 / $251.19 / $575.44