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Virginia rates for HCPCS 77295

3-D Radiotherapy Plan Dose-Volume Histograms

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$202.21 / $353.88 / $605.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$442.21 / $504.96 / $1,028.48
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$198.28 / $221.36 / $419.05
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$238.33 / $306.66 / $489.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$443.16 / $566.71 / $888.03
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$205.90 / $262.45 / $395.32
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$237.25 / $303.39 / $501.61
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$496.13 / $967.45 / $5,062.91
CareFirst
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$243.62 / $244.63 / $244.63
CareFirst
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$251.50 / $251.50 / $490.43
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
$430.96 / $769.04 / $1,565.29
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$194.97 / $297.89 / $559.75
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$229.43 / $421.26 / $1,270.97
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.60 / $646.91 / $679.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$223.01 / $292.45 / $322.63
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$255.58 / $356.90 / $365.72
Medcost
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$326.64 / $440.00 / $666.85
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.00 / $469.00 / $958.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.66 / $658.47 / $4,839.00
Sentara
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$229.87 / $328.56 / $499.54
Sentara
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$287.01 / $409.56 / $1,030.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.43 / $725.78 / $1,694.81
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$184.99 / $277.49 / $417.27
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$243.34 / $400.26 / $1,320.71