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Missouri rates for HCPCS 58740

Lysis of adhesions (salpingolysis, ovariolysis)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $4,677.35 / $8,511.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $4,786.30 / $10,000.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $1,445.44 / $5,888.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $2,398.83 / $4,073.80