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New York 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
$394.09 / $3,100.00 / $7,839.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.56 / $383.22 / $777.67
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,393.00 / $4,113.00 / $8,836.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.25 / $376.80 / $1,012.43
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$399.69 / $1,716.00 / $6,213.00
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$399.69 / $399.69 / $550.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$490.23 / $490.23 / $4,612.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.23 / $557.64 / $1,201.43
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.99 / $495.29 / $1,046.52
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$414.14 / $552.19 / $820.46
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.03 / $457.67 / $732.72
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,581.80 / $14,583.12 / $15,895.29
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$490.23 / $555.00 / $4,612.43
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.81 / $585.47 / $1,249.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,625.00 / $3,496.00 / $5,963.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.38 / $534.00 / $1,107.54
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$326.14 / $326.14 / $1,449.74
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.14 / $553.17 / $808.22