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Vermont rates for HCPCS G0416

Surgical Pathology Gross And Microscopic Examinations For Prostate Needle Biopsy Any Method (Revised 11/11/2014) Revised 1/1/2014

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.25 / $606.19 / $687.21
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$143.80 / $177.78 / $271.14
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$335.02 / $402.76 / $869.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.00 / $455.64 / $521.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.00 / $326.16 / $326.16
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$128.25 / $153.56 / $153.56
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$172.60 / $172.60 / $172.60
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.16 / $328.95 / $651.26
MVP Health Care
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$128.25 / $153.56 / $184.49
MVP Health Care
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$172.60 / $177.76 / $466.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.96 / $348.26 / $1,083.03
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$115.45 / $185.02 / $521.34
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$97.94 / $163.24 / $631.67