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Wisconsin rates for HCPCS 58572

Laparoscopy Total Hysterectomy Uterus >250 Gm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,113.02 / $3,751.64 / $24,976.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,878.00 / $15,141.00 / $22,609.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,588.02 / $3,024.30 / $4,878.09
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,029.13 / $1,256.23 / $3,344.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,113.02 / $7,984.00 / $17,200.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,029.13 / $1,256.23 / $3,344.87
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,039.05 / $3,137.00 / $3,708.88
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27,770.10 / $27,770.10 / $27,770.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,984.00 / $12,373.00 / $15,090.00