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New Hampshire 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
$912.01 / $2,398.83 / $11,481.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $251.19 / $707.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,737.80 / $3,019.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $446.68 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $478.63 / $758.58
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $9,549.93 / $9,549.93
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $416.87 / $707.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $9,549.93 / $9,549.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $426.58 / $758.58