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Utah 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
$7,933.82 / $7,933.82 / $7,933.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,030.12 / $7,933.82 / $8,885.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,821.49 / $2,821.49 / $2,821.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $14,474.71 / $15,821.50
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,170.40 / $3,522.67 / $3,930.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $7,693.00 / $13,847.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,917.41 / $2,986.18 / $4,927.20