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Pennsylvania rates for HCPCS 58740

Lysis of adhesions (salpingolysis, ovariolysis)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $6,165.95 / $9,549.93
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,417.38 / $21,379.62 / $57,543.99
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $5,248.07 / $9,549.93
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $575.44 / $1,819.70
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $691.83 / $891.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,995.26 / $5,011.87