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South Dakota rates for HCPCS 57320

Closure of vesicovaginal fistula; vaginal approach

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $3,548.13 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $524.81 / $1,288.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,288.25 / $1,621.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $870.96 / $1,412.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $977.24 / $5,248.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,230.27 / $1,258.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $933.25 / $1,096.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $1,000.00 / $1,513.56
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,258.93 / $1,318.26