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Wisconsin rates for HCPCS 77412

Radiation treatment delivery; Level 3, multiple isocenters with photon therapy (eg, 2D, 3D, or IMRT) or a single-isocenter photon therapy (eg, 3D or IMRT) with active motion management, or total skin electrons, or mixed-electron/photon field(s), including imaging guidance, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $1,479.11 / $1,995.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $251.19 / $870.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $354.81 / $1,258.93
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $257.04 / $338.84
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $269.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $724.44 / $1,148.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $741.31 / $1,412.54
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $741.31 / $1,122.02
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $446.68 / $501.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $338.84 / $1,479.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $524.81 / $1,548.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $50.12 / $323.59
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $1,047.13 / $1,479.11
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $2,041.74 / $2,041.74
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $1,258.93 / $1,548.82
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $1,445.44
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $2,884.03 / $3,235.94
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,862.09 / $2,754.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $1,479.11 / $1,949.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $426.58 / $1,096.48