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Virginia 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
$272.45 / $4,771.00 / $8,920.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.01 / $272.45 / $425.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,060.00 / $3,693.00 / $4,290.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.71 / $301.43 / $413.41
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.37 / $396.62 / $4,716.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.74 / $337.15 / $622.40
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.02 / $288.02 / $355.23
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$237.23 / $334.38 / $498.60
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.00 / $350.11 / $587.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$258.22 / $332.30 / $3,512.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.22 / $332.30 / $3,512.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,349.00 / $7,061.00 / $12,739.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.51 / $343.53 / $550.24