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Pennsylvania 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
$1,047.13 / $4,786.30 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $251.19 / $707.95
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $5,248.07 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $251.19 / $389.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $323.59 / $501.19
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $346.74 / $389.05
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $323.59 / $489.78
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $3,801.89 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $302.00 / $977.24
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $363.08 / $524.81
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $398.11 / $524.81
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $251.19 / $912.01
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $275.42 / $912.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $3,548.13 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $295.12 / $501.19