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Montana rates for HCPCS 54115

Removal Foreign Body Deep Penile Tissue

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.33 / $2,244.54 / $2,407.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$675.65 / $675.65 / $675.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$510.69 / $707.13 / $751.36
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$358.96 / $835.90 / $864.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.78 / $652.24 / $934.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$680.16 / $771.72 / $1,255.22