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Montana rates for HCPCS 54162

Lysis or excision of penile post-circumcision adhesions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $3,311.31 / $4,677.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $302.00 / $741.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $316.23 / $407.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $316.23 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $331.13 / $426.58
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $436.52 / $478.63
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $436.52 / $478.63
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $316.23 / $489.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $281.84 / $501.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $389.05 / $602.56