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Idaho rates for HCPCS 0655T

Transperineal focal laser ablation of malignant prostate tissue, including transrectal imaging guidance, with MR-fused images or other enhanced ultrasound imaging

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,628.00 / $4,500.00 / $7,205.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,416.26 / $1,464.91 / $1,770.90
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,098.77 / $1,525.48 / $2,119.80
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$816.23 / $816.23 / $816.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $78.00 / $3,900.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,284.43 / $8,522.07 / $10,689.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,338.25 / $2,338.25 / $2,338.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,550.00 / $12,152.00 / $12,233.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,696.21 / $2,349.96 / $3,468.93