go back

Michigan rates for HCPCS G0340

Image guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, second through fifth sessions, maximum five sessions per course of treatment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,653.23 / $3,979.84 / $8,359.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,604.07 / $3,200.00 / $4,783.53
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,042.79 / $4,190.59 / $7,451.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.88 / $714.98 / $919.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$761.26 / $2,316.69 / $2,316.69
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.90 / $3,979.84 / $8,359.26
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.90 / $2,653.23 / $9,900.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,296.00 / $7,500.00 / $10,556.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$716.38 / $1,360.67 / $2,923.99