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Wisconsin rates for HCPCS 63621

Stereotactic Radiosurgery Ea Addl Spinal Lesion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.52 / $210.52 / $832.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.00 / $3,496.00 / $5,962.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$583.02 / $681.31 / $1,045.15
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.52 / $294.73 / $519.04
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$217.41 / $378.94 / $5,261.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.52 / $294.73 / $519.04
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493.70 / $601.91 / $898.55
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,150.48 / $1,150.48 / $1,150.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,723.00 / $3,912.00 / $5,865.00