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South Dakota rates for HCPCS 77371

Radiation Delivery Stereotactic Cranial Cobalt

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,364.21 / $8,364.21 / $8,364.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,026.00 / $14,026.00 / $14,026.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,267.26 / $2,772.35 / $3,465.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,443.30 / $1,702.98 / $2,823.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,103.62 / $2,820.29 / $5,743.87
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,143.17 / $2,385.07 / $3,789.24
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,320.30 / $2,585.91 / $3,121.01
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,382.10 / $1,382.10 / $1,382.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,215.94 / $2,435.54 / $3,754.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,722.40 / $2,026.40 / $2,026.40