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Virginia 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
$1,071.52 / $5,248.07 / $15,135.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $891.25 / $1,380.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,760.83 / $9,332.54 / $21,877.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,000.00 / $1,412.54
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,288.25 / $5,623.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,000.00 / $1,737.80
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $831.76 / $2,089.30
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,445.44 / $1,778.28
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $1,071.52 / $1,621.81
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $1,023.29 / $10,000.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,023.29 / $10,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,760.83 / $12,882.50 / $25,703.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $977.24 / $1,584.89