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Pennsylvania rates for HCPCS 58267

Vaginal hysterectomy, for uterus 250 g or less; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$958.15 / $3,839.00 / $8,247.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$894.13 / $1,016.25 / $1,329.87
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,480.74
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,067.93 / $1,108.23 / $1,108.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,007.48 / $1,361.77 / $2,157.01
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,261.86 / $1,677.58 / $1,677.58
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$832.00 / $4,761.00 / $8,247.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$894.13 / $1,092.59 / $2,806.39
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $1,141.70 / $2,706.70
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,018.17 / $1,379.30 / $2,262.44
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,054.44 / $1,054.44 / $1,147.29
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,019.04 / $1,062.93 / $1,147.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,222.00 / $3,475.00 / $6,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.01 / $1,330.07 / $2,150.81