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Virginia 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
$336.53 / $3,633.00 / $7,275.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.52 / $336.53 / $532.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,714.00 / $9,239.00 / $22,034.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.27 / $399.85 / $612.95
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.31 / $337.47 / $4,117.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$490.23 / $490.23 / $490.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.88 / $483.82 / $779.55
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.16 / $482.70 / $557.01
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$317.69 / $445.55 / $684.37
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.00 / $586.00 / $853.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$285.45 / $423.28 / $805.03
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.47 / $541.89 / $1,136.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,066.00 / $1,893.00 / $4,428.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.82 / $529.30 / $831.33