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Alaska rates for HCPCS 57296

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,839.20 / $10,900.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,577.75 / $4,577.75 / $5,972.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,236.47 / $3,236.47 / $3,236.47
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,188.20 / $4,577.75 / $6,546.18
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,330.58 / $6,052.20 / $7,826.46
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,602.50 / $4,178.89 / $5,863.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,188.20 / $4,577.75 / $6,546.18
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,277.75 / $4,110.00 / $5,998.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,471.89 / $2,589.17 / $5,845.04