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Idaho 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
$1,628.00 / $5,096.95 / $9,520.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.02 / $470.22 / $687.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.09 / $545.14 / $667.33
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.35 / $576.41 / $868.43
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.67 / $559.60 / $786.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $566.12 / $712.22
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,658.49 / $12,222.47 / $15,458.09
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.75 / $541.76 / $752.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,620.00 / $24,707.00 / $38,510.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.70 / $569.26 / $840.67