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Ohio rates for HCPCS 58740

Lysis Of Adhesions Salpinx/Ovary

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,308.78 / $6,251.00 / $11,581.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,426.00 / $12,098.50 / $21,233.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$858.33 / $1,030.00 / $1,274.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,233.00 / $4,383.00 / $6,522.00