| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $501.19 | $3,388.44 | $6,025.60 | |
U of Utah Health Plan
| Professional | $426.58 | $501.19 | $724.44 | |
United
| Facility | $1,071.52 | $4,466.84 | $5,128.61 |
Harvest of upper extremity vein, 1 segment, for lower extremity or coronary artery bypass procedure (List separately in addition to code for primary procedure)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $501.19 | $3,388.44 | $6,025.60 | |
U of Utah Health Plan
| Professional | $426.58 | $501.19 | $724.44 | |
United
| Facility | $1,071.52 | $4,466.84 | $5,128.61 |