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Montana rates for HCPCS 54162

Lysis/Excision Penile Postcircumcision Adhesions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,312.08 / $3,312.08 / $4,710.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.78 / $280.74 / $562.46
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.52 / $316.52 / $406.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.52 / $316.52 / $316.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.52 / $332.32 / $424.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.74 / $491.40 / $507.90
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.74 / $316.52 / $439.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.61 / $316.61 / $4,097.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.28 / $438.48 / $708.56