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Virginia rates for HCPCS 57295

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$539.77 / $5,048.00 / $8,920.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,060.00 / $3,693.00 / $4,290.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$477.48 / $572.98 / $706.67
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$458.80 / $660.24 / $896.52
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$475.54 / $642.14 / $3,512.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,349.00 / $7,061.00 / $12,739.00