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Wisconsin rates for HCPCS 77522

Proton treatment delivery; simple, with compensation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $1,288.25 / $1,288.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $954.99 / $1,778.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,288.25 / $5,011.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,454.71 / $3,981.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $3,467.37 / $3,981.07
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $3,630.78 / $5,128.61
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $1,737.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $1,023.29 / $3,235.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,905.46 / $8,709.64
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $50.12 / $524.81
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $2,238.72 / $3,162.28
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $2,630.27 / $7,244.36
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,365.16 / $8,709.64 / $8,709.64
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $2,511.89
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,467.37 / $4,786.30 / $5,888.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $3,311.31 / $4,365.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,348.96 / $3,090.30