go back

South Dakota rates for HCPCS 57120

Colpocleisis (Le Fort type)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$484.34 / $484.34 / $4,338.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.13 / $818.53 / $1,339.25
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$871.00 / $1,382.13 / $4,114.05
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$622.74 / $869.48 / $1,035.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
80
Low / Median / High Price
$187.88 / $187.88 / $187.88
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$187.88 / $187.88 / $187.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00