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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
$562.34 / $3,548.13 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $562.34 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,412.54 / $1,737.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $891.25 / $1,479.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $1,047.13 / $4,570.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,318.26 / $1,318.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,174.90
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,000.00 / $1,202.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $1,096.48 / $1,621.81
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,380.38 / $1,412.54