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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
$501.19 / $954.99 / $1,949.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $263.03 / $588.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $338.84 / $1,071.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $346.74 / $457.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $60.26 / $478.63
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $812.83 / $1,096.48
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $398.11 / $478.63
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $407.38 / $467.74
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $309.03 / $478.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $331.13 / $436.52