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South Dakota rates for HCPCS C2639

Brachytherapy Source Non-Stranded Iodine-125 Per Source

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.73 / $27.73 / $27.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.73 / $35.92 / $35.92
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.43 / $60.70 / $98.42
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.67 / $52.67 / $61.44