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Montana rates for HCPCS 57291

Construction of artificial vagina; without graft

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.12 / $2,848.11 / $2,848.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$874.93 / $874.93 / $874.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.35 / $874.93 / $875.33
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$428.47 / $951.60 / $1,103.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.19 / $796.86 / $1,149.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$746.64 / $936.96 / $1,529.04