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South Dakota rates for HCPCS 31201

Ethmoidectomy; intranasal, total

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$852.85 / $852.85 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$674.80 / $749.66 / $852.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,673.38 / $1,781.02 / $2,226.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$809.47 / $1,267.18 / $1,988.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$871.22 / $1,468.18 / $5,815.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,113.25 / $1,598.41 / $2,508.02
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,076.00 / $1,702.31 / $2,166.59
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$879.18 / $1,261.53 / $1,513.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$871.22 / $1,646.23 / $2,142.92
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,441.40 / $1,695.80 / $1,763.60