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Pennsylvania rates for HCPCS 57291

Construction of artificial vagina; without graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$921.00 / $4,761.00 / $8,451.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.95 / $506.34 / $680.23
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,431.95 / $7,827.00 / $19,139.18
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.83 / $569.54 / $569.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$523.67 / $705.63 / $1,116.33
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$651.65 / $866.29 / $866.29
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,054.00 / $5,342.00 / $9,617.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$463.24 / $606.70 / $2,843.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.00 / $682.30 / $1,405.70
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$529.80 / $705.63 / $1,282.48
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$540.96 / $540.96 / $559.53
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.23 / $543.79 / $570.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,334.00 / $2,824.00 / $5,678.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$496.06 / $675.33 / $1,087.84