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Maryland rates for HCPCS 77331

Special dosimetry (eg, TLD, microdosimetry) (specify), only when prescribed by the treating physician

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$38.90 / $38.90 / $38.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $83.18 / $208.93
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.02 / $64.57 / $213.80
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$15.14 / $21.88 / $58.88
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $64.57 / $91.20
CareFirst
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.67 / $51.29 / $93.33
CareFirst
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$19.95 / $22.39 / $37.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $77.62 / $173.78
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$36.31 / $54.95 / $123.03
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$15.85 / $23.44 / $53.70
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $75.86 / $114.82
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.71 / $52.48 / $77.62
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$19.95 / $22.91 / $36.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $66.07 / $117.49
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$32.36 / $46.77 / $83.18
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$14.79 / $19.50 / $34.67
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $79.43 / $102.33
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.48 / $54.95 / $69.18
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$15.14 / $23.99 / $31.62