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Wisconsin rates for HCPCS 57426

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$940.84 / $1,773.81 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,692.00 / $15,055.00 / $22,609.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,252.80 / $2,632.58 / $4,246.25
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$867.20 / $946.03 / $1,694.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$940.84 / $6,564.00 / $13,918.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$867.20 / $946.03 / $1,694.97
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,708.85 / $2,593.98 / $3,108.27
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,704.40 / $17,704.40 / $17,704.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,241.00 / $9,837.00 / $12,062.00