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Arizona 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
$936.00 / $2,735.00 / $6,483.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.46 / $348.38 / $657.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.35 / $2,197.38 / $3,616.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.53 / $383.08 / $521.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,100.10 / $4,100.10 / $4,100.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.88 / $437.57 / $731.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$278.39 / $443.29 / $1,331.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.40 / $474.81 / $4,954.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,068.00 / $1,711.00 / $3,268.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.70 / $420.29 / $759.02