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Montana rates for HCPCS 54304

Plastic operation on penis for correction of chordee or for first stage hypospadias repair with or without transplantation of prepuce and/or skin flaps

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$778.21 / $2,132.90 / $3,948.14
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
$1,174.64 / $1,174.64 / $1,174.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$881.05 / $1,174.64 / $1,252.46
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$580.80 / $1,411.15 / $1,444.63
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$708.47 / $1,062.81 / $1,533.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,107.21 / $1,276.17 / $2,040.54