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Wisconsin rates for HCPCS 57300

Closure of rectovaginal fistula; vaginal or transanal approach

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $1,230.27 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $616.60 / $1,230.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $4,897.79 / $8,709.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $1,174.90 / $2,754.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,862.09 / $2,951.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,862.09 / $2,089.30
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $3,801.89 / $7,413.10
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,479.11 / $1,819.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $5,495.41 / $8,317.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $977.24 / $4,570.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $724.44
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,412.54 / $1,995.26
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $9,549.93 / $9,549.93
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $2,818.38 / $4,365.16
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,513.56 / $1,513.56
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $3,235.94 / $3,311.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,897.79 / $7,413.10 / $9,120.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $870.96 / $2,511.89