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Ohio rates for HCPCS 57426

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $7,585.78 / $12,022.64
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $6,918.31 / $30,199.52
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $870.96 / $1,000.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,379.62 / $21,379.62 / $21,379.62
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,379.62 / $21,379.62 / $21,379.62
SummaCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $9,120.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $5,754.40 / $9,120.11