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Arizona rates for HCPCS 77412

Radiation treatment delivery; Level 3, multiple isocenters with photon therapy (eg, 2D, 3D, or IMRT) or a single-isocenter photon therapy (eg, 3D or IMRT) with active motion management, or total skin electrons, or mixed-electron/photon field(s), including imaging guidance, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $501.19 / $1,445.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $288.40 / $741.31
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $416.87 / $489.78
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $676.08 / $1,000.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $1,318.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $707.95 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $316.23 / $478.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $251.19 / $1,621.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $316.23 / $1,548.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $223.87 / $223.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $302.00 / $416.87