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Washington rates for HCPCS 77295

3-D Radiotherapy Plan Dose-Volume Histograms

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$220.09 / $417.50 / $765.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$500.73 / $613.49 / $1,401.66
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$198.28 / $273.58 / $608.61
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$268.69 / $365.62 / $717.93
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$381.81 / $432.32 / $1,277.16
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$189.73 / $236.71 / $448.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$298.07 / $1,325.34 / $2,448.63
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$644.49 / $1,100.19 / $7,381.05
Asuris Northwest Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$306.19 / $530.37 / $1,864.20
Asuris Northwest Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$352.80 / $597.86 / $6,233.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591.37 / $991.59 / $1,559.96
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$275.26 / $453.05 / $715.22
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$327.52 / $536.96 / $863.03
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$208.63 / $510.13 / $4,012.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$484.84 / $1,088.25 / $1,540.31
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$210.58 / $485.96 / $603.47
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$276.52 / $602.29 / $937.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.30 / $435.06 / $969.12
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$330.75 / $421.43 / $448.90
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$267.33 / $383.87 / $492.10
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$311.60 / $454.02 / $672.68
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$298.07 / $298.07 / $306.19
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$734.08 / $1,099.24 / $1,316.95
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$344.18 / $510.74 / $610.16
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$391.26 / $588.50 / $700.28
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$2,448.63 / $2,448.63 / $3,999.35
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$644.49 / $987.77 / $1,300.46
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$304.00 / $458.95 / $601.79
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$340.49 / $526.22 / $716.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$595.35 / $672.35 / $1,357.56
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$267.64 / $290.52 / $580.35
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$318.74 / $392.72 / $800.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.35 / $548.35 / $548.35
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$242.16 / $242.16 / $242.16
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$306.19 / $306.19 / $306.19