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Montana rates for HCPCS 54861

Epididymectomy; bilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $758.58 / $1,412.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $891.25 / $954.99
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $977.24 / $1,174.90
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $977.24 / $1,174.90
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $831.76 / $1,071.52
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $588.84 / $1,174.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $977.24 / $1,412.54