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Maine rates for HCPCS 58750

Tubotubal anastomosis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$921.82 / $921.82 / $975.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,268.63 / $22,395.57 / $25,253.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,005.21 / $1,207.03 / $1,743.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,110.95 / $1,300.25 / $1,973.53
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,013.51 / $1,305.32 / $2,002.42
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$921.82 / $921.82 / $975.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.46 / $1,335.96 / $1,807.54