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South Dakota rates for HCPCS 57320

Closure Vesicovaginal Fistula Vaginal Approach

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$514.41 / $514.41 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.66 / $514.41 / $1,512.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,222.95 / $1,258.25 / $1,572.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$675.64 / $869.35 / $1,402.76
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$629.66 / $1,058.24 / $5,263.72
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$903.00 / $1,438.61 / $4,114.05
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$883.00 / $1,237.97 / $1,528.86
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$671.63 / $935.38 / $1,100.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$486.22 / $982.01 / $1,527.57
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,072.40 / $1,261.59 / $1,312.10