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Montana rates for HCPCS 57292

Construction of artificial vagina; with graft

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$867.31 / $4,326.08 / $4,326.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,312.92 / $1,312.92 / $1,312.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$932.85 / $1,312.92 / $1,349.66
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$643.27 / $1,460.55 / $1,531.92
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$799.05 / $1,198.69 / $1,729.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.70 / $1,411.86 / $2,302.31