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Ohio rates for HCPCS 77522

Proton treatment delivery; simple, with compensation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $933.25 / $2,041.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $891.25 / $1,819.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $109.65 / $181.97
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $831.76 / $831.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $912.01 / $1,778.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,584.89 / $2,570.40
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $4,365.16 / $4,570.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $50.12 / $60.26
SummaCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $1,548.82
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $60.26 / $60.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $954.99 / $3,019.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,023.29 / $1,584.89