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Pennsylvania rates for HCPCS 57400

Dilation of vagina under anesthesia (other than local)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$657.00 / $2,747.00 / $8,017.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.20 / $123.13 / $197.27
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,058.35 / $6,182.00 / $17,094.48
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.25 / $135.16 / $257.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.06 / $173.97 / $267.36
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.94 / $204.74 / $204.74
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,676.03 / $3,676.03 / $3,676.03
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$918.00 / $3,077.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.35 / $139.33 / $700.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $161.80 / $327.30
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.16 / $179.13 / $299.83
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.86 / $126.86 / $133.01
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.52 / $127.96 / $133.04
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
$126.42 / $163.09 / $265.14