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Pennsylvania rates for HCPCS 57426

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$921.00 / $4,761.00 / $8,451.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,058.35 / $6,182.00 / $17,094.48
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,054.00 / $5,342.00 / $9,617.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$855.70 / $855.70 / $1,025.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,222.00 / $3,475.00 / $6,000.00