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Utah 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
$1,507.44 / $3,084.00 / $4,707.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,416.26 / $1,507.44 / $1,602.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $60.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,086.24 / $6,609.94 / $9,632.58
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,620.09 / $1,800.10 / $1,800.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,981.00 / $3,613.00 / $7,048.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,551.00 / $1,880.01 / $3,384.00