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Arizona rates for HCPCS 77295

3-Dimensional Radiotherapy Plan, Including Dose-Volume Histograms

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$309.45 / $689.23 / $935.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$499.68 / $596.72 / $2,300.52
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$198.28 / $258.47 / $1,183.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$264.70 / $348.92 / $1,494.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.74 / $508.94 / $532.07
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$273.88 / $376.41 / $376.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$492.95 / $505.59 / $631.99
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$236.22 / $236.22 / $295.27
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$262.63 / $269.37 / $537.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.18 / $808.62 / $1,257.84
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$189.86 / $289.00 / $457.39
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$210.32 / $406.60 / $852.75
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$528.44 / $1,325.34 / $1,325.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.10 / $918.08 / $7,381.05
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$251.18 / $286.68 / $1,699.00
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$308.64 / $578.41 / $6,233.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$556.70 / $758.20 / $1,144.46
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$238.29 / $282.81 / $412.57
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$288.42 / $343.77 / $873.02