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Maryland rates for HCPCS 58573

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $8,128.31 / $13,182.57
Aetna
Facility/Professional
Facility
Modifier
22
Low / Median / High Price
$4,897.79 / $4,897.79 / $4,897.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $5,128.61 / $5,128.61
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,318.26 / $2,398.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $3,548.13