go back

South Dakota rates for HCPCS 77763

Intracavitary radiation source application; complex

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$805.55 / $805.55 / $805.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$702.07 / $702.07 / $805.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,518.69 / $1,857.03 / $2,321.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$909.42 / $1,186.50 / $1,766.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$763.86 / $1,372.52 / $1,710.26
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$566.07 / $1,550.16 / $2,676.94
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,121.00 / $1,710.26 / $2,010.85
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$786.45 / $1,208.71 / $1,548.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$677.22 / $937.91 / $1,478.02
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,474.70 / $1,734.90 / $1,734.90