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South Dakota rates for HCPCS 77772

Hdr Rdncl Ntrstl/Intrcav Brachytx >12 Channels

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$288.79 / $288.79 / $288.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$814.14 / $888.75 / $1,540.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,758.49 / $2,150.23 / $2,687.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.12 / $1,647.27 / $2,046.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,711.78 / $2,046.44 / $2,405.19
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$979.32 / $1,557.37 / $1,775.74
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$289.75 / $469.06 / $551.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,024.99 / $1,106.30 / $1,843.84
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,691.60 / $1,990.10 / $1,990.10