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South Dakota rates for HCPCS 77770

Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 1 channel

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$104.90 / $104.90 / $104.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.43 / $363.57 / $590.40
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$90.89 / $104.90 / $334.64
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$219.11 / $258.67 / $426.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$673.71 / $823.79 / $1,029.74
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$195.39 / $238.92 / $298.64
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$478.32 / $584.88 / $731.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.92 / $612.45 / $740.44
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$113.40 / $192.92 / $283.44
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$247.10 / $424.75 / $634.37
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.63 / $740.44 / $922.56
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.20 / $576.85 / $678.60
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.51 / $170.47 / $200.54
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$244.45 / $406.38 / $478.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.50 / $417.42 / $647.96
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$113.40 / $125.14 / $201.80
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$247.10 / $295.58 / $446.16
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.40 / $760.50 / $760.50
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$191.00 / $224.80 / $224.80
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$455.40 / $535.79 / $535.79