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Pennsylvania 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
$954.00 / $4,102.00 / $8,427.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$709.83 / $785.33 / $2,102.50
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,154.97 / $1,154.97 / $1,154.97
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,431.95 / $7,827.00 / $19,139.18
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.00 / $1,076.07 / $1,429.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$743.71 / $997.71 / $1,547.21
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$911.51 / $1,204.14 / $1,219.29
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,465.72 / $10,393.37 / $18,335.64
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $4,734.00 / $8,451.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$721.56 / $921.09 / $2,184.55
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $936.30 / $1,934.90
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$751.90 / $1,016.19 / $1,592.87
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$757.11 / $757.11 / $850.34
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.24 / $758.69 / $850.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,718.00 / $3,879.00 / $7,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$712.83 / $899.84 / $1,544.88