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Hawaii rates for HCPCS 58615

Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $4,466.84 / $4,466.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $251.19 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $295.12 / $316.23
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $446.68 / $7,943.28
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $269.15 / $338.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $309.03 / $398.11
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $346.74 / $3,548.13