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Maine 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
$654.32 / $654.32 / $667.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$495.86 / $495.86 / $800.57
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$866.44 / $1,002.47 / $1,880.87
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$654.32 / $654.32 / $667.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$606.97 / $828.68 / $1,525.60