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Michigan 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
$1,530.66 / $2,877.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$958.19 / $1,530.66 / $1,770.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,753.18 / $4,753.18 / $4,753.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,515.52 / $4,943.31 / $6,416.79
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,877.00 / $2,877.00 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,070.78 / $1,530.66 / $1,770.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $50.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,524.00 / $5,819.00 / $8,339.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.48 / $2,204.30 / $3,156.23