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Illinois rates for HCPCS 58740

Lysis of adhesions (salpingolysis, ovariolysis)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $3,715.35 / $9,772.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,365.16 / $11,748.98 / $22,908.68
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,479.11 / $3,311.31
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $3,388.44 / $6,165.95