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Utah rates for HCPCS 77522

Proton treatment delivery; simple, with compensation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $1,819.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,000.00 / $1,819.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,621.81 / $5,128.61
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $60.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $4,168.69 / $5,248.07
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,445.44 / $1,621.81
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,023.29 / $1,096.48
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,380.38 / $1,445.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,122.02 / $1,659.59