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Montana rates for HCPCS 54405

Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders, and reservoir

Insurance Carrier
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,258.93
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $1,380.38 / $1,698.24
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $1,174.90 / $1,548.82