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South Dakota rates for HCPCS 69637

Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); 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
$1,404.22 / $1,404.22 / $4,338.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,402.67 / $2,373.13 / $3,883.11
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,287.00 / $3,663.21 / $5,269.25
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,725.55 / $2,344.01 / $2,724.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00