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Utah rates for HCPCS 77402

Radiation treatment delivery; Level 1 (eg, single-electron field, multiple-electron fields, or 2D photons), including imaging guidance, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $1,949.84 / $1,949.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $131.83 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $141.25 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $190.55 / $234.42
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $56.23 / $309.03
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $407.38 / $562.34
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $218.78 / $269.15
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $81.28 / $302.00
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $190.55 / $234.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $218.78 / $288.40