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Utah 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
$316.23 / $5,888.44 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $251.19 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $338.84 / $549.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $501.19
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,365.16 / $5,128.61 / $12,022.64
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $436.52 / $537.03
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $398.11 / $524.81
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $389.05 / $562.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $5,128.61 / $7,079.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $288.40 / $524.81