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South Dakota rates for HCPCS 63621

Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); each additional spinal lesion (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $223.87 / $223.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $371.54 / $676.08
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $537.03 / $549.54
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $446.68 / $489.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26