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Montana rates for HCPCS 39503

Repair, neonatal diaphragmatic hernia, with or without chest tube insertion and with or without creation of ventral hernia

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,046.81 / $6,241.14 / $15,751.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,991.18 / $8,991.18 / $8,991.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,387.36 / $8,991.18 / $10,384.04
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,417.09 / $10,513.10 / $11,088.99
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,523.44 / $8,286.01 / $11,951.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,248.74 / $10,351.34 / $15,779.56