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Michigan rates for HCPCS 57295

Revision (including removal) of prosthetic vaginal graft; vaginal approach

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$594.49 / $4,112.00 / $6,621.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,494.90 / $2,912.30 / $3,967.35
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$497.85 / $4,112.00 / $5,756.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,524.00 / $5,819.00 / $8,339.00