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South Dakota rates for HCPCS 51925

Closure of vesicouterine fistula; with hysterectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,096.48 / $1,584.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,454.71 / $3,019.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $1,659.59 / $2,884.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,862.09 / $7,943.28
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,344.23 / $2,398.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,137.96 / $2,137.96
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,819.70 / $2,089.30
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
$1,122.02 / $1,949.84 / $2,818.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,454.71 / $2,511.89