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South Dakota rates for HCPCS 69805

Endolymphatic Sac W/O Shunt

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,011.11 / $1,011.11 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$849.41 / $1,011.11 / $2,953.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,248.90 / $2,318.60 / $2,898.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,214.66 / $1,708.78 / $2,843.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,244.59 / $2,074.34 / $8,569.23
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,749.00 / $2,736.59 / $5,269.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,641.00 / $2,248.90 / $2,781.49
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,289.63 / $1,753.27 / $1,998.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,244.59 / $2,167.01 / $2,856.95
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,948.10 / $2,291.90 / $2,383.50