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Wisconsin rates for HCPCS 63620

Stereotactic Radiosurgery 1 Spinal Lesion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$967.61 / $967.61 / $3,863.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,740.00 / $4,780.00 / $11,302.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,720.48 / $3,179.10 / $4,876.82
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$967.61 / $1,354.65 / $2,333.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$967.61 / $1,741.70 / $14,270.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$967.61 / $1,354.65 / $2,333.86
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,248.92 / $2,741.90 / $4,093.12
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,438.08 / $10,438.08 / $10,438.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,154.00 / $11,891.00 / $15,090.00