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Arizona rates for HCPCS 57291

Construction of artificial vagina; without graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,965.00 / $4,521.00 / $7,963.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$482.53 / $535.86 / $2,848.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$944.35 / $3,532.98 / $5,814.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$471.87 / $629.16 / $786.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,100.10 / $4,100.10 / $4,100.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$490.63 / $652.47 / $1,144.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.49 / $734.29 / $3,911.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.32 / $640.50 / $5,060.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,343.00 / $3,339.00 / $5,838.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$486.07 / $603.90 / $1,057.01