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Indiana 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
Facility
Modifier
Low / Median / High Price
$432.18 / $432.18 / $432.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.22 / $432.18 / $908.31
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$801.89 / $951.97 / $3,500.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$440.68 / $801.89 / $1,106.59
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$612.91 / $9,193.82 / $13,790.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$504.27 / $693.81 / $6,565.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$944.47 / $1,058.49 / $1,058.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$564.22 / $656.47 / $1,128.44