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Arizona rates for HCPCS 0395T

High dose rate electronic brachytherapy, interstitial or intracavitary treatment, per fraction, includes basic dosimetry, when performed

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$625.37 / $748.71 / $1,084.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.84 / $2,186.88 / $3,464.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,524.30 / $1,563.38 / $3,117.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,684.72 / $1,899.00 / $2,392.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,084.19 / $1,084.19 / $1,420.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219.89 / $748.71 / $2,352.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.47 / $719.72 / $4,140.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$673.03 / $719.72 / $1,405.32