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Oregon 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
$489.78 / $1,023.29 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $363.08 / $776.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $691.83 / $1,096.48
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $660.69 / $977.24
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $562.34 / $977.24
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $630.96 / $977.24
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $724.44 / $794.33
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $537.03 / $870.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $691.83 / $1,000.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,120.11 / $15,488.17 / $19,054.61
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $758.58 / $1,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $3,715.35 / $21,877.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $676.08 / $1,023.29