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South Dakota rates for HCPCS 69633

Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis [PORP], total ossicular replacement prosthesis [TORP])

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $4,365.16 / $6,025.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,659.59 / $2,884.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,290.87 / $2,398.83
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,778.28 / $2,041.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $4,466.84