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Montana rates for HCPCS 54415

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

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $831.76 / $831.76
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $933.25 / $1,096.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $776.25 / $1,000.00