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Utah 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
$568.04 / $902.46 / $2,075.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.24 / $386.45 / $431.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$276.06 / $337.57 / $1,068.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.37 / $348.83 / $412.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $60.00 / $477.22
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$399.88 / $517.24 / $775.64
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$341.55 / $426.87 / $499.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.81 / $329.76 / $435.29