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Montana rates for HCPCS 54901

Epididymovasostomy Anast Epididymis Bi

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,089.78 / $1,097.07 / $5,568.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,657.85 / $1,657.85 / $1,657.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,178.84 / $1,657.85 / $1,779.76
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$820.02 / $1,966.90 / $2,032.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.91 / $1,501.52 / $2,165.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,543.25 / $1,818.31 / $2,885.07