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Vermont rates for HCPCS 77295

3-D Radiotherapy Plan Dose-Volume Histograms

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$589.00 / $589.00 / $613.49
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$231.59 / $236.86 / $236.86
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$352.14 / $352.14 / $381.89
BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$1,340.82 / $1,340.82 / $1,340.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$672.89 / $672.89 / $2,028.00
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$292.61 / $292.61 / $947.73
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$373.43 / $373.43 / $373.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$642.96 / $911.30 / $2,028.00
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$299.58 / $309.24 / $947.73
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$343.37 / $383.25 / $690.68
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$642.96 / $911.30 / $2,028.00
MVP Health Care
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$299.58 / $309.24 / $947.73
MVP Health Care
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$343.37 / $383.25 / $690.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.29 / $1,050.09 / $2,157.26
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$227.94 / $304.04 / $1,008.14
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$259.75 / $437.07 / $1,194.52