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Wisconsin rates for HCPCS 77403

Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks; 6-10 MeV

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.29 / $369.61 / $567.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.13 / $222.67 / $378.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$471.07 / $471.07 / $471.07
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$385.08 / $385.08 / $385.08
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.77 / $471.07 / $471.07