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Montana rates for HCPCS 54112

Excision of penile plaque (Peyronie disease); with graft greater than 5 cm in length

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $1,479.11 / $1,479.11
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,621.81 / $1,949.84
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $1,348.96 / $1,778.28