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Maine 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
$253.90 / $253.90 / $267.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.97 / $329.09 / $487.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.43 / $380.85 / $553.53
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.17 / $363.41 / $557.50
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.90 / $253.90 / $267.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.44 / $373.06 / $507.69