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South Dakota rates for HCPCS 55876

Plmt Interstitial Dev Radiat Tx Prostate 1/Mult

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.14 / $141.47 / $4,205.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.03 / $144.40 / $211.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.52 / $290.20 / $429.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.40 / $219.43 / $355.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.41 / $327.14 / $1,130.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$227.97 / $308.66 / $1,610.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.97 / $270.47 / $359.68
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.99 / $215.59 / $286.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.99 / $262.85 / $408.88
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.50 / $236.80 / $344.80