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Wisconsin 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
$275.42 / $512.86 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $251.19 / $630.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $4,786.30 / $7,585.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $489.78 / $1,148.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $758.58 / $1,230.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $758.58 / $870.96
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $3,981.07 / $7,413.10
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $616.60 / $776.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $5,495.41 / $8,317.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $467.74 / $2,818.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $323.59
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $575.44 / $794.33
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $9,549.93 / $9,549.93
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $1,318.26 / $2,818.38
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $630.96 / $630.96
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $1,348.96 / $1,380.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,897.79 / $7,413.10 / $9,120.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $398.11 / $1,047.13