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Pennsylvania rates for HCPCS 58575

Laparoscopy, surgical, total hysterectomy for resection of malignancy (tumor debulking), with omentectomy including salpingo-oophorectomy, unilateral or bilateral, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,301.00 / $3,839.00 / $9,534.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,480.74
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,094.68 / $6,535.31 / $21,469.94
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,013.00 / $4,761.00 / $8,451.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,893.72 / $1,893.72 / $2,076.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,222.00 / $3,475.00 / $6,000.00