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South Dakota rates for HCPCS 79200

Radiopharmaceutical therapy, by intracavitary administration

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $138.04 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $138.04 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $316.23 / $389.05
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $199.53 / $478.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $190.55 / $309.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $309.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $229.09 / $251.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $213.80 / $295.12
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $263.03 / $263.03