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Maine rates for HCPCS 58571

Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,253.87 / $9,904.66 / $25,525.28
Community Health Options
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,628.73 / $21,628.73 / $21,628.73
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,026.91 / $15,088.01 / $28,309.17