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Pennsylvania rates for HCPCS 57295

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$832.00 / $3,839.00 / $8,104.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,058.35 / $6,182.00 / $17,094.48
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,807.51 / $7,762.55 / $18,355.58
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$937.00 / $4,070.00 / $8,017.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$408.70 / $475.74 / $493.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,334.00 / $2,824.00 / $5,678.00