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Virginia rates for HCPCS 58740

Lysis of adhesions (salpingolysis, ovariolysis)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $5,888.44 / $10,964.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $16,218.10 / $21,877.62
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,000.00 / $2,511.89
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,479.11 / $2,089.30
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $1,230.27 / $1,819.70
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $1,174.90 / $8,709.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $7,079.46 / $14,125.38