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New Jersey 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
$415.00 / $5,458.00 / $9,383.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.47 / $349.57 / $532.11
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,277.15 / $19,277.15 / $19,277.15
AmeriHealth
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,222.30 / $1,222.30 / $1,222.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.45 / $500.17 / $1,032.67
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.16 / $606.19 / $671.77
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,685.21 / $11,558.82 / $13,645.35
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.15 / $398.15 / $656.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,354.00 / $3,961.00 / $10,536.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.03 / $519.02 / $878.72