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Wisconsin rates for HCPCS 58740

Lysis Of Adhesions Salpinx/Ovary

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$965.41 / $1,821.42 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,479.00 / $9,695.00 / $15,579.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,299.66 / $2,687.33 / $4,334.57
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$890.47 / $1,089.51 / $1,779.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$965.41 / $2,257.50 / $8,384.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$906.33 / $1,089.51 / $1,779.96
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,774.50 / $2,710.68 / $3,227.68
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,382.76 / $7,382.76 / $7,382.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,918.00 / $6,477.00 / $8,384.00