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Genital Reconstruction Surgery

Pennsylvania rates for HCPCS 55970

Reconstructs the genitals as part of gender-affirming care, reshaping and rebuilding the existing tissue to match the person's gender identity. It is major surgery, usually the last step after hormone treatment and a period of living in the affirmed gender, and it is often done in more than one stage. Recovery involves a hospital stay and a long period of careful aftercare.

Rates data updated July 2026.

How much does Genital Reconstruction Surgery cost?

$4,074

Typical negotiated rate. In Pennsylvania, July 2026.

Insurers have agreed to pay about $4,074 for this service. The price depends on where it is billed: about $3,890 from a physician practice, and about $5,370 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 4 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$3,890$3,548 to $6,166
FacilityA hospital or hospital-owned outpatient department$5,370$3,467 to $7,762

How much rates vary

Facilitymedian $5,370 · 10th to 90th $1,096 to $8,511Professionalmedian $3,890 · 10th to 90th $3,467 to $9,772
$1K$2K$5K$10Kfacility $5,370professional $3,890

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$1,412.54
Median
$5,370.32
Typical High
$8,317.64
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3,467.37
Median
$3,801.89
Typical High
$9,772.37
Cigna
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$4,365.16
Typical High
$7,079.46
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$4,786.30
Typical High
$8,317.64
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$3,467.37
Median
$3,801.89
Typical High
$9,772.37
United
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$3,890.45
Typical High
$12,882.50
United
Setting
Professional
Modifier
Global
Typical Low
$3,311.31
Median
$4,466.84
Typical High
$7,413.10

Where Pennsylvania sits

The same service costs 4.4 times more in Alaska than in North Dakota. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Pennsylvania· 46th of 51

$4,074

AK $16,218ND $3,715

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.