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Michigan 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
$4,073.80 / $4,073.80 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $251.19 / $380.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $239.88 / $380.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $380.19 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $309.03 / $416.87
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $4,073.80 / $5,754.40
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $295.12 / $407.38
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $302.00 / $398.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $5,011.87 / $8,912.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $316.23 / $407.38