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Pennsylvania rates for HCPCS 63620

Stereotactic Radiosurgery 1 Spinal Lesion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,157.18 / $1,157.18 / $23,354.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,291.78 / $1,291.78 / $1,291.78
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,157.18 / $21,879.00 / $23,354.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,291.78 / $1,291.78 / $1,291.78
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$756.64 / $1,107.14 / $1,107.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,468.00 / $4,563.00 / $9,631.00