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Vermont 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
$5,011.87 / $5,011.87 / $5,011.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $158.49 / $371.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $177.83 / $208.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $169.82 / $331.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $204.17 / $416.87