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Wisconsin 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
$851.14 / $1,621.81 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $912.01 / $3,311.31
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,964.78 / $17,378.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,513.56 / $3,548.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $2,344.23 / $3,801.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $2,511.89 / $2,818.38
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $4,786.30 / $8,912.51
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,949.84 / $2,454.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $7,585.78 / $15,848.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,318.26 / $3,801.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,023.29
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,737.80 / $2,398.83
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,772.37 / $9,772.37 / $14,454.40
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $3,801.89 / $5,754.40
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $3,801.89 / $3,801.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,760.83 / $12,302.69 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,258.93 / $3,388.44