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Idaho 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
$456.15 / $594.69 / $721.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$969.97 / $2,004.60 / $2,391.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,108.99 / $1,108.99 / $1,108.99
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$334.62 / $599.77 / $923.48
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.57 / $248.57 / $248.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$929.64 / $1,169.55 / $1,169.55
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,357.65 / $1,919.60 / $2,212.79
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$956.20 / $956.20 / $1,005.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.22 / $820.59 / $1,236.92