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Hawaii 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
$1,157.88 / $2,747.00 / $3,883.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.47 / $348.38 / $449.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.98 / $489.02 / $522.03
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.95 / $617.17 / $709.76
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.29 / $431.31 / $584.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,106.00 / $1,106.00 / $1,106.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.25 / $522.03 / $625.20
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.66 / $380.67 / $3,831.00