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Indiana 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
$283.06 / $712.01 / $7,212.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.27 / $336.98 / $453.33
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.41 / $240.41 / $240.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,234.00 / $5,126.00 / $8,388.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$412.78 / $551.16 / $760.60
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.45 / $343.43 / $496.92
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.56 / $422.92 / $552.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,982.66 / $2,982.66 / $2,982.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.86 / $500.97 / $868.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,638.00 / $2,854.00 / $4,271.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.30 / $467.49 / $735.70