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South Dakota 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
$707.95 / $3,548.13 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $851.14 / $1,905.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,819.70 / $2,290.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $1,122.02 / $2,187.76
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,380.38 / $5,888.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,698.24 / $1,819.70
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,584.89 / $1,584.89
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,288.25 / $1,513.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $4,466.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,445.44 / $2,137.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,737.80 / $1,819.70