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Virginia rates for HCPCS 57426

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$949.24 / $6,146.00 / $14,187.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,900.00 / $13,875.00 / $15,752.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$828.52 / $994.22 / $1,226.21
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$783.14 / $1,121.82 / $1,550.70
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$888.70 / $1,128.74 / $5,122.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,303.00 / $9,373.00 / $17,192.00