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Wisconsin rates for HCPCS 54417

Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$965.35 / $1,844.19 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$905.76 / $965.35 / $2,994.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,183.00 / $15,738.00 / $23,778.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$882.39 / $2,337.98 / $5,077.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,314.98 / $2,705.23 / $4,363.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,221.26 / $2,799.29 / $3,706.60
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$901.60 / $1,235.34 / $1,762.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$965.35 / $1,957.00 / $4,793.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,031.03 / $2,154.10 / $4,746.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $737.50 / $1,905.22
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$901.60 / $1,235.34 / $1,762.23
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,756.95 / $2,713.00 / $3,195.76
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54,004.00 / $54,004.00 / $54,004.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,247.46 / $4,384.39 / $6,696.32
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,447.46 / $2,447.46 / $2,447.46
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,580.23 / $4,333.89 / $4,333.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,367.00 / $3,088.30 / $4,295.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$995.61 / $2,681.25 / $4,286.80