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Vermont rates for HCPCS 76857

Us Pelvic Nonobstetric Image Dcmtn Limited/F/U

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.61 / $82.84 / $340.90
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.92 / $28.57 / $98.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$18.48 / $63.61 / $139.03
BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$114.54 / $114.54 / $114.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.02 / $120.49 / $206.95
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.08 / $58.34 / $98.95
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$56.77 / $64.97 / $64.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.76 / $109.74 / $206.95
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.50 / $34.01 / $98.95
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$31.36 / $53.99 / $120.54
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.73 / $109.74 / $206.95
MVP Health Care
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.19 / $34.01 / $98.95
MVP Health Care
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$31.36 / $38.97 / $120.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.44 / $98.95 / $149.56
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.72 / $29.81 / $54.04
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$24.18 / $55.92 / $114.88