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Hawaii rates for HCPCS G0339

Image guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session or first session of fractionated treatment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,123.30 / $18,123.30 / $18,123.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,179.51 / $6,893.03 / $9,693.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,821.49 / $2,821.49 / $2,821.49
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,705.43 / $5,585.67 / $6,178.84
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,233.25 / $3,766.90 / $4,394.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $2,912.00 / $2,912.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,171.64 / $4,542.97 / $5,064.60
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,578.35 / $3,130.86 / $3,683.36