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Pennsylvania rates for HCPCS 57330

Closure of vesicovaginal fistula; transvesical and vaginal approach

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$677.78 / $3,839.00 / $8,247.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$615.99 / $709.07 / $938.99
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
$766.86 / $795.80 / $795.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$731.25 / $976.66 / $1,525.82
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$895.56 / $1,184.94 / $1,191.90
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$677.78 / $4,761.00 / $8,247.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$632.54 / $746.01 / $1,998.35
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$898.10 / $1,071.09 / $1,929.10
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$744.49 / $979.80 / $1,582.06
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$748.16 / $748.16 / $832.56
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$726.48 / $750.78 / $832.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $3,475.00 / $6,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$722.02 / $939.09 / $1,521.90