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Alaska rates for HCPCS 57155

Insertion of uterine tandem and/or vaginal ovoids for clinical brachytherapy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,146.03 / $7,340.00 / $13,413.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.61 / $1,379.84 / $1,847.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$980.26 / $980.26 / $1,259.67
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$364.67 / $1,847.80 / $2,586.92
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$699.50 / $1,816.50 / $2,679.33
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,081.25 / $1,564.21 / $2,223.44
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$364.67 / $1,890.38 / $2,586.92
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$594.28 / $1,392.60 / $2,307.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$972.10 / $1,048.45 / $2,235.83