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South Dakota rates for HCPCS 54901

Epididymovasostomy, anastomosis of epididymis to vas deferens; bilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $954.99 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,096.48 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,398.83 / $3,019.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,479.11 / $2,884.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,905.46 / $8,128.31
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,290.87 / $2,454.71
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,137.96 / $2,137.96
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,819.70 / $2,041.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,995.26 / $2,951.21
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,344.23 / $2,454.71