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Montana 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
Professional
Modifier
Low / Median / High Price
$741.31 / $1,000.00 / $2,041.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $1,230.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $1,230.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,230.27 / $1,258.93
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,348.96 / $1,584.89
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,348.96 / $1,584.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $1,148.15 / $1,445.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $794.33 / $1,584.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,318.26 / $1,905.46