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Maryland 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
Professional
Modifier
Low / Median / High Price
$213.80 / $269.15 / $741.31
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $275.42 / $446.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $1,778.28 / $1,778.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $338.84 / $660.69
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $275.42 / $446.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $1,621.81 / $1,621.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $302.00 / $501.19
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $302.00 / $363.08