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South Dakota rates for HCPCS 69801

Labyrinthotomy, with perfusion of vestibuloactive drug(s), transcanal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $229.09 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $213.80 / $436.52
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$338.84 / $338.84 / $338.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $354.81 / $660.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $323.59 / $1,174.90
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $389.05 / $6,456.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $288.40 / $489.78
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $257.04 / $436.52
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $331.13 / $489.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $323.59 / $562.34
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $288.40 / $524.81