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Michigan 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
$1,144.11 / $4,933.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$808.54 / $1,144.11 / $1,191.79
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,339.05 / $5,064.97 / $6,899.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.98 / $941.83 / $1,534.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$850.16 / $1,034.81 / $1,967.77
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$999.32 / $4,933.00 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$999.32 / $1,061.17 / $1,460.73
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.68 / $770.00 / $1,200.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,906.00 / $4,645.00 / $6,327.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,038.30 / $1,235.73 / $1,575.87