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Montana rates for HCPCS 54390

Plastic Rpr Penis Epispadias W/Exstrophy Bladder

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,292.02 / $6,530.82 / $6,530.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,941.78 / $1,941.78 / $1,941.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,397.28 / $1,941.78 / $2,089.38
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$960.29 / $2,233.40 / $2,348.46
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,173.33 / $1,760.18 / $2,538.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,752.36 / $2,151.60 / $3,379.02