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South Carolina rates for HCPCS 55876

Plmt Interstitial Dev Radiat Tx Prostate 1/Mult

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.58 / $4,230.00 / $13,594.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.65 / $147.47 / $277.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,200.00 / $2,984.83 / $5,452.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.00 / $163.72 / $286.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,224.14 / $1,224.14 / $1,573.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.42 / $174.20 / $304.77
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.08 / $178.67 / $261.52
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.84 / $139.66 / $1,083.06
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.22 / $187.73 / $293.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$659.00 / $6,607.00 / $8,667.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.19 / $198.41 / $365.24