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North Carolina 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
$384.42 / $1,181.00 / $6,953.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.16 / $383.22 / $669.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.52 / $797.54 / $1,086.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$490.23 / $490.23 / $490.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$396.56 / $584.74 / $983.67
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$277.48 / $490.00 / $912.01
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.00 / $460.00 / $932.81
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$376.93 / $595.40 / $967.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$713.00 / $2,417.00 / $7,895.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$376.23 / $560.03 / $1,072.01
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,429.42 / $1,429.42 / $16,394.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,954.00 / $4,954.00 / $4,954.00