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South Dakota rates for HCPCS 77373

Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,230.27 / $6,606.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,398.83 / $2,951.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,778.28 / $2,884.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,905.46 / $2,238.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,862.09 / $2,754.23
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,137.96 / $2,137.96