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South Dakota rates for HCPCS 69604

Revj Mastoidectomy Rsltg Tympanoplasty

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,104.01 / $1,104.01 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$923.82 / $1,104.01 / $3,109.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,424.29 / $2,516.48 / $3,145.62
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,293.60 / $1,865.78 / $3,080.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,316.36 / $2,193.94 / $8,291.52
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,847.00 / $2,960.01 / $5,269.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,709.00 / $2,424.29 / $3,018.09
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,369.20 / $1,857.80 / $2,154.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,440.53 / $1,971.18 / $3,066.28
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,100.00 / $2,470.60 / $2,569.40