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Washington rates for HCPCS 57426

Revision Prosthetic Vaginal Graft Laparoscopic

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,607.11 / $5,116.62 / $20,680.40
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,175.54 / $20,128.48 / $40,963.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,437.81 / $4,437.81 / $7,393.34
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,080.58 / $1,960.34 / $6,933.22
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,212.70 / $1,620.44 / $1,764.11
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,175.54 / $1,203.28 / $2,928.53
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,886.25 / $21,402.13 / $40,963.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $3,297.00 / $12,835.00