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Montana rates for HCPCS 54401

Insertion of penile prosthesis; inflatable (self-contained)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$689.73 / $3,486.35 / $3,486.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,052.13 / $1,052.13 / $1,052.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.81 / $1,052.13 / $1,092.41
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$520.97 / $1,217.45 / $1,256.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$628.88 / $943.42 / $1,360.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$955.23 / $1,119.82 / $1,820.40