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Montana rates for HCPCS 57155

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.46 / $300.33 / $399.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$445.88 / $445.88 / $629.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$445.88 / $445.88 / $445.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$414.09 / $480.73 / $705.97
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$279.45 / $609.10 / $732.55
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.56 / $447.00 / $690.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$566.80 / $690.85 / $1,097.97