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Montana rates for HCPCS 54901

Epididymovasostomy, anastomosis of epididymis to vas deferens; bilateral

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,380.38 / $2,630.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $1,659.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,659.59 / $1,778.28
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $1,819.70 / $2,187.76
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $1,819.70 / $2,187.76
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $1,548.82 / $2,041.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,096.48 / $2,187.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,819.70 / $2,630.27