go back

South Dakota rates for HCPCS 69501

Transmastoid antrotomy (simple mastoidectomy)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$705.03 / $705.03 / $4,338.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$844.60 / $1,191.50 / $1,969.19
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,206.00 / $1,911.78 / $5,269.25
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.76 / $1,211.40 / $1,381.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00