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Pennsylvania rates for HCPCS 58572

Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g;

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $5,079.00 / $10,689.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $11,851.00 / $28,970.26
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,994.03 / $28,275.47 / $54,090.87
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,301.00 / $5,350.00 / $10,689.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.80 / $1,020.80 / $1,357.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,304.00 / $4,563.00 / $8,261.00