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Pennsylvania rates for HCPCS 63621

Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); each additional spinal lesion (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.18 / $257.18 / $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
$287.58 / $287.58 / $287.58
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.18 / $21,879.00 / $23,354.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$287.58 / $287.58 / $287.58
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$228.57 / $246.00 / $246.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.00 / $2,391.00 / $4,789.00