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Michigan rates for HCPCS 57426

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,033.07 / $4,933.00 / $5,757.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,218.55 / $6,091.62 / $8,298.45
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$893.22 / $4,933.00 / $5,757.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,296.00 / $7,849.00 / $9,202.00