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Texas rates for HCPCS 57426

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$983.00 / $3,912.00 / $11,210.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,029.89 / $10,059.78 / $19,976.73
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$760.27 / $760.27 / $760.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,480.54 / $4,480.54 / $4,480.54
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $17,704.40
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$815.96 / $1,098.00 / $1,846.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$823.21 / $1,102.08 / $1,894.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,634.00 / $4,345.00 / $10,600.00