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Maine rates for HCPCS 77295

3-D Radiotherapy Plan Dose-Volume Histograms

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$239.96 / $239.96 / $239.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$504.95 / $557.72 / $807.73
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$198.28 / $225.01 / $359.02
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$276.02 / $343.24 / $449.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$492.41 / $639.46 / $916.91
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$232.26 / $300.57 / $426.03
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$260.14 / $336.66 / $490.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$580.41 / $828.77 / $1,096.46
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$273.23 / $381.51 / $516.16
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$307.18 / $447.26 / $580.29
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.40 / $695.82 / $1,305.52
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$280.70 / $324.77 / $609.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$320.69 / $371.04 / $696.15
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$504.95 / $580.70 / $1,043.14
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$198.28 / $239.96 / $410.09
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$276.02 / $343.24 / $542.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.26 / $696.40 / $1,235.39
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$224.09 / $314.02 / $498.23
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$241.17 / $383.86 / $696.15