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South Dakota rates for HCPCS 77761

Intracavitary radiation source application; simple

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$435.87 / $435.87 / $435.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$378.88 / $378.88 / $435.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$816.44 / $998.33 / $1,247.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$471.22 / $640.30 / $931.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.76 / $735.35 / $904.49
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$374.17 / $904.49 / $1,447.76
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$517.00 / $904.49 / $1,086.46
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.25 / $641.22 / $828.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.47 / $505.31 / $786.30
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$789.40 / $928.70 / $928.70