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Montana rates for HCPCS 55876

Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $28,840.32 / $28,840.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $154.88 / $309.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $162.18 / $239.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $162.18 / $162.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $169.82 / $239.88
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $229.09 / $281.84
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $229.09 / $281.84
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $162.18 / $251.19
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $158.49 / $288.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $204.17 / $338.84