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Texas rates for HCPCS 57295

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$714.00 / $3,102.00 / $10,234.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,123.38 / $3,922.02 / $7,537.78
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$439.27 / $4,329.29 / $4,329.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,403.30 / $2,403.30 / $2,403.30
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $9,496.40
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$476.27 / $635.79 / $1,052.07
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$476.27 / $639.51 / $1,293.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,154.00 / $3,314.00 / $7,600.00