Male Reproductive Surgery · 55860
Surgical Opening Of Prostate For Radiation Therapy
What Medicare pays for 55860, what providers bill, and how the price varies across 0 states, drawn from CMS 2023 claims data.
- $719.50
- Medicare pays
- $2,317.90
- Providers bill
- 3.2×
- Markup
- #8,694 of 9,297
- Volume rank
The verdict
Surgical Opening Of Prostate For Radiation Therapy pairs modest national service volume with one of the smaller markups in the catalog.
- 6th pct.
- national service volume
- 18th pct.
- billed-to-Medicare markup
- 3.2×
- billed vs. Medicare
- $719.50
- Medicare pays, national avg
Volume percentile ranks this code's national service volume against every tracked procedure; markup percentile ranks its billed-to-Medicare ratio the same way. The same two figures drive both the verdict sentence and the chips above.
According to the Centers for Medicare & Medicaid Services (CMS), the 2023 Medicare Physician & Other Practitioners dataset records payments for 9,297 procedure codes billed across 5,426 hospitals in 56 states and territories; see our methodology for how each figure is sourced and computed.
What You Might Pay
Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
How we estimate these prices
These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024). We map each PlainProcedure category onto a RAND CPT-section bucket (Surgery, Radiology, Pathology and Laboratory, Medicine, Anesthesia, Evaluation and Management) or fall back to the national average when no bucket matches. For Male Reproductive Surgery, the applied ratio is 2.54x Medicare (RAND 2024 Surgery bucket (2.54x) + CMS Medicare baseline). Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.
Where this markup sits nationally
Markup (billed ÷ Medicare) across 8,901 procedures with a meaningful Medicare rate
3 more affordable than 18% of 8,901 procedures
Each bar is a 1-wide band; taller bars hold more procedures. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.
Source CMS Medicare Physician & Other Practitioners · 2023
What the billed charge breaks down into
$2,317.90
What the Data Says About Surgical Opening Of Prostate For Radiation Therapy
Across 0 states with reporting providers, CPT code 55860 (Surgical Opening Of Prostate For Radiation Therapy) shows a national average Medicare payment of $719.50 against an average billed charge of $2,317.90. That gap, a 3.2x markup, or 222% above the Medicare allowed amount, is among the tightest billed-to-paid spreads we track, this code's chargemaster rate tracks unusually close to the Medicare benchmark.
Male Reproductive Surgery procedures like this one saw 29 services billed to Medicare in 2023 by 10 distinct providers, serving 27 unique beneficiaries. Regional variation is limited in the underlying CMS file. Where state-level figures exist for surgical opening of prostate for radiation therapy, Geographic Practice Cost Indices (GPCIs), local malpractice premiums, and practice-expense adjustments are the usual drivers of any difference. Applying the RAND 2024 commercial-to-Medicare ratio for this category (2.54x Medicare; RAND 2024 Surgery bucket (2.54x) + CMS Medicare baseline), the estimated commercial insurance price lands near $2,311.62, with self-pay cash discounts commonly bringing the figure closer to $1,319.99. Within Male Reproductive Surgery, Surgical Opening Of Prostate For Radiation Therapy ranks #15 of 105 tracked procedures by national average Medicare payment.
Where this sits in the registry
Surgical Opening Of Prostate For Radiation Therapy (55860) is a CMS 2023 Part B code. These pages keep the volume map and the markup map separate.
- National volume versus markup on the statistics page, the same two maps as this capsule. Statistics
- Other Male Reproductive Surgery codes, ranked by Medicare payment inside the category. Category
- How volume rank and markup rank are computed. Methodology
- The full procedures listing in volume order. Procedures
Figures here are CMS averages, not a quote for any patient, plan, or visit.
Frequently Asked Questions
Where does Surgical Opening Of Prostate For Radiation Therapy rank among Medicare procedures?
According to CMS Medicare Part B claims, Surgical Opening Of Prostate For Radiation Therapy (CPT 55860) ranks #8,694 of 9,297 procedures by national service volume, the same sort as the procedures listing, and #15 of 105 within Male Reproductive Surgery by national average Medicare payment. See /methodology#corpus-placement.
How much does Surgical Opening Of Prostate For Radiation Therapy cost?
The national average Medicare payment for Surgical Opening Of Prostate For Radiation Therapy (CPT 55860) is $719.50, while providers typically bill $2,317.90.
Why do providers charge more than Medicare pays?
Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.
How much does Surgical Opening Of Prostate For Radiation Therapy cost with insurance?
Commercial insurers pay well above Medicare for surgical opening of prostate for radiation therapy, an estimated $2,311.62 on average (range: $1,618.13-$3,236.26), versus $719.50 from Medicare. Without insurance, the estimated cash price is $1,319.99.
How many providers perform Surgical Opening Of Prostate For Radiation Therapy?
Surgical Opening Of Prostate For Radiation Therapy is comparatively uncommon: only 10 providers nationally billed Medicare for it in 2023, serving 27 beneficiaries via 29 total services.
What is the billed-to-Medicare markup for Surgical Opening Of Prostate For Radiation Therapy?
Providers bill 3.2x what Medicare pays for Surgical Opening Of Prostate For Radiation Therapy - one of the smaller markups in the catalog at 222% above the Medicare rate.
Nationwide similar CPT codes
Data-derived peers across the CMS Physician & Other Practitioners extract: nearest national service volume and nearest average Medicare payment. Not clinical substitutes: claim-mass and payment neighborhoods only.
Closest average Medicare payment
Nearest codes with payment ≥ $5 ($719.50 here).
Related Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, the data changelog, or report a data error.