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Utah rates for HCPCS 77525

Proton treatment delivery; complex

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $9,549.93 / $9,549.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,288.25 / $2,570.40
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
$1,659.59 / $1,862.09 / $2,089.30
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,348.96 / $1,412.54
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,778.28 / $1,862.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,445.44 / $2,089.30