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Michigan 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
$1,000.00 / $4,897.79 / $10,964.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $891.25 / $1,995.26
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $794.33 / $794.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $741.31 / $1,174.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,174.90 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $891.25 / $1,318.26
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $4,073.80 / $10,964.78
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $912.01 / $1,380.38
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $891.25 / $1,230.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $7,943.28 / $15,135.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $977.24 / $1,288.25