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Idaho rates for HCPCS 54415

Removal of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis, without replacement of prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,897.00 / $4,500.00 / $7,761.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$609.99 / $921.33 / $1,144.69
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,789.17 / $8,522.07 / $10,689.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,360.00 / $16,762.00 / $17,870.00