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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
$1,237.85 / $1,237.85 / $2,123.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,065.14 / $15,647.20 / $17,644.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,438.28 / $1,647.63 / $2,596.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,520.73 / $1,854.10 / $2,656.32
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,376.41 / $1,772.70 / $2,719.41
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,237.85 / $1,237.85 / $2,123.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,304.27 / $1,965.26 / $2,452.37