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California rates for HCPCS 57426

Revision (including removal) of prosthetic vaginal graft, laparoscopic approach

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,392.00 / $9,008.00 / $20,509.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,629.00 / $7,362.00 / $16,460.00
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.00 / $100.00 / $11,729.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,943.21 / $12,122.00 / $14,696.00
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.94 / $983.02 / $1,327.08
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$878.37 / $1,130.47 / $1,998.79
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $5,650.40 / $17,704.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$860.86 / $1,100.65 / $1,586.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,728.00 / $9,758.00 / $22,073.00