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Wisconsin 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
$575.44 / $1,096.48 / $14,454.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,317.64 / $13,489.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $1,621.81 / $2,570.40
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $2,454.71 / $4,786.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $7,079.46 / $12,302.69
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,230.27 / $1,698.24
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,309.57 / $9,332.54 / $9,332.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,232.93 / $12,589.25