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Washington rates for HCPCS 58572

Laparoscopy Total Hysterectomy Uterus >250 Gm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,211.77 / $7,920.26 / $48,571.45
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,897.00 / $27,770.10 / $55,801.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,960.89 / $6,960.89 / $11,596.76
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,405.48 / $2,396.44 / $12,028.17
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,656.99 / $2,001.29 / $2,252.54
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,395.24 / $1,396.59 / $4,000.25
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,916.23 / $29,070.27 / $55,801.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,028.00 / $4,686.00 / $20,708.00