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Pennsylvania 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
$455.24 / $2,747.00 / $8,113.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.22 / $341.58 / $569.80
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.94 / $342.57 / $368.13
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.69 / $3,159.00 / $14,886.03
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$399.04 / $414.10 / $414.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$490.23 / $490.23 / $490.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.60 / $458.10 / $778.76
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$510.42 / $623.05 / $638.64
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,914.35 / $16,341.58 / $34,199.49
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.75 / $306.04 / $309.95
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$631.49 / $2,679.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.61 / $372.83 / $1,038.25
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.97 / $557.15 / $967.30
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$490.23 / $490.23 / $490.23
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.35 / $467.58 / $787.89
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$278.14 / $379.61 / $387.25
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.14 / $379.61 / $410.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$412.00 / $1,305.00 / $3,742.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.00 / $491.04 / $773.80