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Michigan rates for HCPCS 58954

Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking; with pelvic lymphadenectomy and limited para-aortic lymphadenectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $4,933.00 / $4,933.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,370.09 / $12,105.02 / $16,490.36
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,214.64 / $4,933.00 / $4,933.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,906.00 / $4,645.00 / $6,327.00