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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
$812.83 / $812.83 / $4,365.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $1,348.96 / $2,238.72
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,778.28 / $1,862.09
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,380.38 / $1,584.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53