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Pennsylvania rates for HCPCS 77295

3-D Radiotherapy Plan Dose-Volume Histograms

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$207.99 / $287.23 / $701.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.13 / $557.72 / $2,233.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$198.28 / $264.94 / $991.76
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$213.04 / $337.33 / $1,310.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$376.17 / $376.17 / $381.81
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$174.63 / $217.97 / $428.64
AmeriHealth
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$195.77 / $246.78 / $398.43
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.46 / $755.62 / $2,176.17
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$227.18 / $355.46 / $529.92
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$247.28 / $399.60 / $1,772.91
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$256.04 / $256.04 / $256.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.60 / $724.04 / $1,478.92
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$183.26 / $274.33 / $437.62
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$233.28 / $426.65 / $1,125.13
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$547.09 / $748.91 / $1,152.08
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$250.96 / $303.01 / $337.84
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$296.12 / $368.28 / $411.07
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$542.57 / $948.34 / $988.03
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$243.75 / $265.70 / $368.20
Independence Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$227.26 / $241.17 / $398.43
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$207.99 / $334.32 / $734.25
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.68 / $616.97 / $1,554.99
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$207.95 / $315.62 / $652.02
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$223.69 / $352.25 / $1,153.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.34 / $478.46 / $1,006.54
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$256.04 / $256.04 / $256.04
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.90 / $724.04 / $1,436.19
Priority Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$191.99 / $274.33 / $439.77
Priority Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$235.02 / $417.89 / $1,153.08
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$221.41 / $221.41 / $230.86
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$454.83 / $461.31 / $1,185.30
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$216.43 / $221.41 / $230.86
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$234.93 / $239.91 / $954.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$428.93 / $622.54 / $1,153.64
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$204.89 / $261.80 / $422.30
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$224.04 / $323.62 / $704.90