go back

Wisconsin rates for HCPCS 58740

Lysis of adhesions (salpingolysis, ovariolysis)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $1,819.70 / $14,454.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,165.95 / $10,232.93 / $18,197.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $2,691.53 / $4,265.80
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $6,918.31 / $13,489.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $5,128.61 / $8,317.64
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $2,089.30 / $2,884.03
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $7,244.36 / $7,244.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $7,413.10 / $9,120.11