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Pennsylvania rates for HCPCS 58573

Laparoscopy Tot Hysterectomy >250 G W/Tube/Ovar

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,974.97 / $9,666.54 / $33,893.36
Aetna
Facility/Professional
Facility
Modifier
22
Low / Median / High Price
$14,679.68 / $16,501.68 / $16,501.68
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,958.46 / $8,307.18 / $69,495.81
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
$8,964.59 / $22,614.64 / $45,436.08
Highmark BCBS
Facility/Professional
Facility
Modifier
22
Low / Median / High Price
$43,035.28 / $43,035.28 / $43,035.28
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,958.46 / $8,845.37 / $44,214.44
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,804.82 / $8,923.00 / $35,575.76
Martin's Point
Facility/Professional
Facility
Modifier
22
Low / Median / High Price
$14,679.68 / $14,679.68 / $16,501.68
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,195.25 / $1,195.25 / $1,527.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,304.00 / $4,563.00 / $8,261.00