go back

Utah 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
$181.97 / $3,019.95 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $141.25 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $169.82 / $281.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $239.88
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,454.71 / $5,623.41
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $181.97 / $234.42
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $194.98 / $371.54
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $194.98 / $309.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $144.54 / $251.19