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Utah rates for HCPCS 77387

Guidance for localization of target volume for delivery of radiation treatment, includes intrafraction tracking, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $467.74 / $575.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $134.90 / $218.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $123.03 / $389.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $89.13 / $234.42
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.47 / $51.29 / $67.61
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $131.83 / $213.80
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $199.53 / $199.53
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $144.54 / $204.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $100.00 / $194.98