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Montana rates for HCPCS 54328

1-Stage Distal Hypospadias Repair (With Or Without Chordee Or Circumcision); With Extensive Dissection To Correct Chordee And Urethroplasty With Local Skin Flaps, Skin Graft Patch, And/Or Island Flap

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$964.59 / $974.86 / $4,939.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,468.03 / $1,468.03 / $1,468.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,087.72 / $1,468.03 / $1,569.65
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$725.98 / $1,751.75 / $1,796.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$885.74 / $1,328.75 / $1,916.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,374.44 / $1,625.41 / $2,551.15