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South Dakota rates for HCPCS 55875

Transperineal Plmt Ndl/Caths Prostate Radj Insj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$708.38 / $708.38 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$708.38 / $779.92 / $1,232.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,716.86 / $1,777.91 / $2,222.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$939.15 / $1,109.91 / $2,180.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$836.25 / $1,520.46 / $5,835.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,315.00 / $2,022.16 / $4,555.17
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,428.70 / $1,716.86 / $2,066.90
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$957.49 / $1,290.10 / $1,526.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $10,167.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.28 / $1,520.46 / $2,154.57
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,487.20 / $1,749.70 / $1,819.70