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Utah rates for HCPCS 57291

Construction of artificial vagina; without graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $4,570.88 / $9,332.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $602.56 / $954.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $776.25 / $1,202.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $3,981.07
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,244.36 / $8,511.38 / $19,498.45
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,000.00 / $3,890.45
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $870.96 / $1,122.02
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $851.14 / $1,202.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $5,128.61 / $7,079.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $602.56 / $1,122.02