Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
PR Imrt Plan Inc Dose-Volume Histograms for Target & Critical Structure|PROFESSIONAL COMPONENT
Troy, NY
See all hospitals reporting CPT 77301 →Price type
Samaritan Hospital’s median price of $1.1k is 55% below the median hospital's median price ($2.4k), higher than 5% of the 1,948 hospitals reporting CPT 77301. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 34 payers, 107 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | UnitedHealthcare united healthcare medicaid harp chip facility · fee schedule · both | $86 | $86 | — | — | — | $86 – $86 |
| 2 | Anthem empire medicaid facility · fee schedule · both | $111 | $111 | — | — | — | $111 – $111 |
| 3 | Excellus empire medicaid facility · fee schedule · both | $111 | $111 | — | — | — | $111 – $111 |
| 4 | Aetna workers comp professional · fee schedule · inpatient | $173 | $173 | — | — | — | $173 – $173 |
| 5 | Anthem empire medicaid essential 1 2 3 4 facility · fee schedule · both | $235 | $235 | — | — | — | $235 – $235 |
| 6 | Excellus empire medicaid essential 1 2 3 4 facility · fee schedule · both | $235 | $235 | — | — | — | $235 – $235 |
| 7 | UnitedHealthcare uhc essential plan medicaid facility · fee schedule · both | $292 | $292 | — | — | — | $292 – $292 |
| 8 | Humana tricare professional · fee schedule · inpatient | $385 | $385 | — | — | — | $385 – $385 |
| 9 | Humana tricare professional · fee schedule · outpatient | $385 | $385 | — | — | — | $385 – $385 |
| 10 | Tricare tricare professional · fee schedule · inpatient | $385 | $385 | — | — | — | $385 – $385 |
| 11 | Tricare tricare professional · fee schedule · outpatient | $385 | $385 | — | — | — | $385 – $385 |
| 12 | Aetna pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 13 | Ambetter pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 14 | Amerihealth Caritas pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 15 | Anthem pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges | $1.1k | $1.1k | — | — | 2–20 | $1.1k – $1.1k |
| 16 | Blue Cross Blue Shield pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges | $1.1k | $1.1k | — | — | 2–20 | $1.1k – $1.1k |
| 17 | Carefirst pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 18 | Caresource pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 19 | Cigna pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges | $1.1k | $1.1k | — | — | 1–10 | $1.1k – $1.1k |
| 20 | Clover pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 21 | Devoted pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 22 | Excellus pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 23 | First Health pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 24 | Highmark pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges | $1.1k | $1.1k | — | — | 2–20 | $1.1k – $1.1k |
| 25 | Humana pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
Last updated: Mar 31, 2026
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