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Nebraska rates for HCPCS 57295

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,382.00 / $8,477.27 / $19,276.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,474.97 / $6,064.74 / $11,385.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$495.45 / $880.75 / $7,772.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$924.94 / $1,242.08 / $3,093.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,217.00 / $6,451.00 / $7,934.00