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New York rates for HCPCS 57426

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,182.46 / $5,630.00 / $12,400.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,989.00 / $9,720.00 / $16,411.00
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,231.50 / $2,644.00 / $12,319.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$995.88 / $995.88 / $12,209.00
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.00 / $1,210.00 / $2,271.46
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$597.00 / $995.88 / $12,209.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,264.00 / $5,768.00 / $11,200.00
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,001.88 / $1,001.88 / $2,083.52