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Arizona rates for HCPCS 58740

Lysis of adhesions (salpingolysis, ovariolysis)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $4,786.30 / $8,317.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $5,370.32 / $7,943.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $1,318.26 / $5,128.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $3,162.28 / $5,370.32