go back

Wisconsin rates for HCPCS 57295

Revj/Rmvl Prosthetic Vaginal Graft Vaginal App

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$543.91 / $1,023.84 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,740.00 / $4,780.00 / $7,344.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,303.02 / $1,522.68 / $2,456.03
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.54 / $546.04 / $978.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$543.91 / $5,496.00 / $8,783.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.54 / $546.04 / $978.34
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$984.10 / $1,480.31 / $1,790.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,496.40 / $9,496.40 / $9,496.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,614.00 / $6,477.00 / $8,384.00