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New Hampshire rates for HCPCS 55874

Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.29 / $4,452.30 / $6,658.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.28 / $341.37 / $6,658.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,769.10 / $5,299.00 / $8,600.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.14 / $391.82 / $5,418.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.00 / $683.69 / $8,767.43
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.17 / $3,028.68 / $9,348.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,399.00 / $12,399.00 / $12,399.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,283.32 / $6,708.18 / $13,162.52
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.56 / $2,515.52 / $4,086.17