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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
$5,248.07 / $6,025.60 / $15,848.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,912.51 / $8,912.51 / $8,912.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,456.54 / $8,912.51 / $10,471.29
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,772.37 / $10,000.00 / $10,964.78
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,772.37 / $10,000.00 / $10,964.78
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,370.32 / $7,413.10 / $10,471.29
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $6,025.60 / $12,022.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,317.64 / $10,232.93 / $14,791.08