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South Dakota rates for HCPCS 69667

Repair Round Window Fistula

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$804.92 / $804.92 / $804.92
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$923.47 / $1,360.31 / $2,240.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,321.00 / $2,091.67 / $2,528.87
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$996.84 / $1,353.03 / $1,567.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00