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South Dakota rates for HCPCS 63620

Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 spinal lesion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,028.54 / $1,028.54 / $1,028.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,013.31 / $1,626.57 / $2,855.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,612.45 / $2,420.84 / $3,487.22
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,415.46 / $1,914.08 / $2,239.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,357.00 / $5,357.00 / $5,357.00