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Utah rates for HCPCS 77317

Brachytherapy isodose plan; intermediate (calculation[s] made from 5 to 10 sources, or remote afterloading brachytherapy, 2-12 channels), includes basic dosimetry calculation(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$104.82 / $104.82 / $104.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.01 / $259.18 / $1,661.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.06 / $342.83 / $590.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.77 / $200.16 / $315.41
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$616.40 / $616.40 / $616.40
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.24 / $493.47 / $535.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.08 / $364.95 / $481.73