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Tennessee rates for HCPCS 58740

Lysis of adhesions (salpingolysis, ovariolysis)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,150.00 / $3,329.00 / $7,602.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,375.00 / $2,387.00 / $4,372.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $7,198.87 / $7,382.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,695.00 / $3,616.00 / $6,285.00