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Wisconsin rates for HCPCS 77404

Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks; 11-19 MeV

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.34 / $411.73 / $631.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.43 / $248.04 / $421.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.55 / $525.55 / $525.55
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$424.02 / $424.02 / $424.02
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$304.33 / $525.55 / $525.55