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Michigan rates for HCPCS 54390

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,575.02 / $4,933.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,214.18 / $1,575.02 / $1,575.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,832.57 / $6,808.37 / $9,274.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.25 / $1,203.14 / $2,036.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,147.83 / $1,467.56 / $2,536.84
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,271.57 / $4,933.00 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,271.57 / $1,399.00 / $1,979.85
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.87 / $1,032.96 / $1,566.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,069.00 / $8,847.00 / $10,652.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,358.88 / $1,639.20 / $2,075.60