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South Dakota rates for HCPCS 77768

Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed; lesion diameter over 2.0 cm and 2 or more channels, or multiple lesions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$75.51 / $75.51 / $75.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.47 / $330.47 / $382.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$711.13 / $869.56 / $1,086.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.03 / $655.49 / $797.65
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$677.49 / $797.65 / $971.73
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.71 / $607.64 / $714.82
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$75.68 / $122.08 / $143.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$428.23 / $673.70 / $713.72
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$681.00 / $801.10 / $801.10