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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
$1,047.66 / $1,047.66 / $4,338.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,146.43 / $1,770.55 / $2,909.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,689.00 / $2,777.16 / $5,269.25
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,284.85 / $1,742.34 / $2,040.97
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00