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Michigan rates for HCPCS 59121

Surgical treatment of ectopic pregnancy; tubal or ovarian, without salpingectomy and/or oophorectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$975.33 / $4,933.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$692.47 / $923.21 / $983.53
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,728.94 / $4,352.79 / $5,929.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.02 / $756.20 / $1,367.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$732.80 / $852.96 / $1,623.44
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$876.06 / $4,933.00 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$876.06 / $885.86 / $1,240.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.98 / $505.57 / $932.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,296.00 / $7,849.00 / $9,202.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.14 / $1,030.66 / $1,336.25