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New Hampshire rates for HCPCS 54405

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $2,754.23 / $11,481.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,964.78 / $20,892.96 / $23,442.29
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,589.25 / $12,589.25 / $12,589.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,589.25 / $12,589.25 / $12,589.25