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Louisiana rates for HCPCS 77295

3-D Radiotherapy Plan Dose-Volume Histograms

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$237.81 / $360.08 / $388.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$504.95 / $695.92 / $808.44
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$198.28 / $332.29 / $396.09
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$306.66 / $363.63 / $449.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$554.33 / $554.33 / $554.33
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$176.59 / $248.63 / $270.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.91 / $709.54 / $863.95
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$262.97 / $344.67 / $408.97
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$288.95 / $364.87 / $463.00
Christus
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$206.42 / $226.91 / $226.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.14 / $494.18 / $1,071.58
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$154.13 / $233.04 / $393.84
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$162.01 / $257.23 / $547.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$390.44 / $576.01 / $1,228.50
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$178.29 / $245.70 / $388.15
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$193.29 / $296.82 / $910.62