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South Dakota rates for HCPCS 57310

Closure Urethrovaginal Fistula

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$452.11 / $452.11 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.62 / $452.11 / $1,323.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,073.21 / $1,123.46 / $1,404.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$574.60 / $764.07 / $1,224.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$550.38 / $924.70 / $5,058.97
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$784.00 / $1,235.56 / $6,152.06
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$753.00 / $1,084.41 / $1,319.89
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$586.86 / $799.73 / $963.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$504.52 / $864.00 / $1,344.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$939.40 / $1,105.09 / $1,149.30