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South Dakota rates for HCPCS 57300

Closure of rectovaginal fistula; vaginal or transanal approach

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$558.98 / $558.98 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.29 / $552.29 / $967.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,277.79 / $1,371.22 / $1,714.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$656.52 / $884.95 / $1,481.73
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.68 / $1,138.35 / $4,558.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$882.00 / $1,527.86 / $2,929.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.00 / $1,309.73 / $1,651.36
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$695.50 / $967.49 / $1,194.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.68 / $1,092.80 / $1,629.68
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,163.80 / $1,369.20 / $1,423.90