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Wisconsin 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
$208.93 / $467.74 / $467.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $4,570.88 / $7,079.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $676.08 / $1,096.48
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $457.09 / $5,754.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $467.74 / $5,623.41
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $549.54 / $812.83
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $588.84 / $1,513.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $3,630.78 / $6,456.54