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Utah 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
$47.86 / $47.86 / $47.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $67.61 / $154.88
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.02 / $47.86 / $229.09
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$15.14 / $19.95 / $40.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $83.18 / $120.23
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$54.95 / $60.26 / $85.11
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$21.88 / $25.12 / $34.67
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $117.49
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$229.09 / $229.09 / $229.09
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $112.20 / $131.83
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$67.61 / $79.43 / $95.50
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$28.84 / $33.11 / $37.15
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $120.23 / $141.25
Select Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.65 / $85.11 / $102.33
Select Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$17.78 / $33.88 / $38.90
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $67.61 / $123.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $81.28 / $114.82
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.12 / $57.54 / $79.43
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$22.91 / $23.99 / $33.11