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Pennsylvania 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
$267.64 / $702.19 / $1,521.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.32 / $219.18 / $261.30
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.17 / $173.17 / $173.17
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$320.14 / $1,173.60 / $12,129.78
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.54 / $241.32 / $241.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$260.42 / $644.24 / $1,066.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.60 / $273.54 / $483.55
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.86 / $274.58 / $396.19
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.93 / $706.77 / $1,151.31
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$297.44 / $297.44 / $305.56
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.33 / $792.95 / $7,717.18
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.41 / $781.92 / $1,531.50
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.31 / $224.39 / $459.22
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$871.16 / $900.19 / $1,159.60
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.30 / $478.50 / $814.50
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$256.87 / $581.37 / $1,011.56
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.98 / $274.23 / $492.75
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$222.42 / $222.42 / $222.42
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.42 / $222.42 / $226.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.80 / $263.81 / $456.08