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Idaho rates for HCPCS 57426

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,415.00 / $4,500.00 / $8,439.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,009.54 / $1,369.06 / $1,948.35
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,306.08 / $18,816.75 / $23,096.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,360.00 / $16,762.00 / $17,870.00