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North Dakota rates for HCPCS 58740

Lysis of adhesions (salpingolysis, ovariolysis)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $891.25 / $8,511.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,479.11 / $2,691.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,677.35 / $5,128.61 / $5,128.61