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Montana rates for HCPCS 53454

Periurethral transperineal adjustable balloon continence device; percutaneous adjustment of balloon(s) fluid volume

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.74 / $27.74 / $27.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.20 / $65.20 / $65.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.20 / $65.20 / $65.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.17 / $45.45 / $65.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.35 / $50.98 / $68.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.64 / $37.76 / $84.46