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Maine rates for HCPCS 54390

Plastic operation on penis for epispadias distal to external sphincter; with exstrophy of bladder

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,548.82 / $2,754.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,302.69 / $13,182.57 / $17,782.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,905.46 / $2,570.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,698.24 / $2,754.23
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,698.24 / $2,454.71
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,737.80 / $3,715.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,819.70 / $2,454.71