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Nebraska 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
$4,265.80 / $7,585.78 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $281.84 / $1,380.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,754.40 / $7,585.78 / $14,791.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $380.19 / $562.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $562.34 / $741.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $512.86 / $7,943.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $512.86 / $2,818.38
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $562.34 / $794.33
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $457.09 / $645.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $4,897.79 / $8,128.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $467.74 / $616.60