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South Dakota rates for HCPCS C2634

Brachytherapy source, nonstranded, high activity, iodine-125, greater than 1.01 mCi (NIST), per source

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.22 / $104.22 / $104.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.22 / $212.83 / $212.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.03 / $359.68 / $583.15
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$244.26 / $244.26 / $284.97