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Montana rates for HCPCS 53405

Urethroplasty; second stage (formation of urethra), including urinary diversion

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,099.08 / $4,598.47 / $4,598.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,369.71 / $1,369.71 / $1,369.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$999.40 / $1,369.71 / $1,459.07
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$677.68 / $1,635.40 / $1,674.86
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$825.57 / $1,238.49 / $1,786.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,283.16 / $1,487.98 / $2,381.88