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California rates for HCPCS 77295

3-D Radiotherapy Plan Dose-Volume Histograms

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$210.54 / $220.92 / $1,342.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$503.30 / $613.49 / $2,393.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$206.00 / $278.35 / $1,064.36
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$292.23 / $351.60 / $1,494.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.64 / $462.67 / $1,178.75
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$215.24 / $436.34 / $611.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.16 / $915.93 / $2,163.01
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$244.52 / $306.24 / $616.17
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$401.65 / $563.46 / $1,557.01
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$559.13 / $813.60 / $1,825.71
Blue Shield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$201.29 / $287.55 / $700.96
Blue Shield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$357.84 / $511.56 / $1,139.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$438.43 / $826.12 / $1,948.65
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$193.25 / $285.75 / $636.28
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$247.38 / $480.80 / $1,419.12
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.75 / $616.17 / $831.84
Contra Costa Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$184.79 / $261.29 / $352.74
Contra Costa Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$244.96 / $354.89 / $479.10
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$471.60 / $619.26 / $1,158.42
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$224.33 / $322.97 / $539.21
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$273.85 / $416.50 / $667.19
Lucent Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$528.44 / $1,325.34 / $1,325.34
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,381.05 / $7,602.48 / $7,602.48
Lucent Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$1,699.00 / $1,699.00 / $1,841.48
Lucent Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$6,233.93 / $6,420.95 / $6,420.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$449.84 / $868.13 / $1,721.78
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$197.00 / $285.75 / $611.99
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$247.38 / $508.64 / $1,350.65
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,625.77 / $1,625.77 / $1,625.77
Sutter Health Plus
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$744.32 / $744.32 / $744.32
Sutter Health Plus
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$881.45 / $881.45 / $881.45
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.29 / $685.15 / $1,982.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$469.20 / $640.16 / $1,632.55
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$177.27 / $290.52 / $728.39
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$277.64 / $345.92 / $1,030.20