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Washington rates for HCPCS 77373

Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,218.85 / $2,290.11 / $7,105.74
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,783.34 / $1,783.34 / $1,783.34
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,388.31 / $2,321.36 / $8,883.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,996.59 / $1,996.59 / $1,996.59
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,402.75 / $2,624.50 / $3,753.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.00 / $1,534.08 / $2,609.69
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,364.15 / $1,364.15 / $1,364.15
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,388.31 / $2,065.62 / $2,935.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,273.74 / $1,871.40 / $2,867.59
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,155.03 / $1,155.03 / $1,155.03