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Maine rates for HCPCS 55875

Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $3,311.31 / $3,467.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $891.25 / $2,344.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,202.26 / $1,659.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,071.52 / $1,737.80
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,047.13 / $1,548.82
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $3,311.31 / $3,467.37
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $912.01 / $2,398.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,071.52 / $1,698.24