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Arkansas rates for HCPCS 77295

3-D Radiotherapy Plan Dose-Volume Histograms

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$243.25 / $308.70 / $370.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.23 / $516.54 / $986.73
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$150.16 / $243.25 / $292.75
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$173.06 / $306.66 / $693.98
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$849.50 / $849.50 / $849.50
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$289.85 / $358.09 / $373.22
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$378.98 / $378.98 / $378.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.01 / $635.30 / $705.90
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$230.83 / $305.51 / $339.45
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$249.19 / $329.81 / $366.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.48 / $810.87 / $1,983.44
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$235.75 / $353.63 / $467.96
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$293.39 / $416.21 / $1,232.05
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$840.83 / $840.83 / $976.93
Qualchoice
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$333.33 / $411.80 / $429.20
Qualchoice
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$435.83 / $435.83 / $435.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.29 / $796.37 / $1,661.84
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$202.21 / $263.39 / $418.36
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$231.08 / $398.00 / $1,076.90