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South Dakota rates for HCPCS 77762

Intracavitary Radiation Source Applic Intermed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$571.50 / $571.50 / $571.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.27 / $497.27 / $571.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,072.08 / $1,310.93 / $1,638.67
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$642.66 / $840.39 / $1,283.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$538.84 / $972.50 / $1,200.98
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$430.78 / $1,095.75 / $1,901.67
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$783.00 / $1,200.98 / $1,430.72
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$558.09 / $897.94 / $1,090.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.59 / $682.93 / $1,098.84
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,038.40 / $1,221.59 / $1,221.59