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Michigan 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
$606.36 / $606.36 / $606.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.16 / $606.36 / $606.36
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$648.71 / $648.71 / $648.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.27 / $681.15 / $875.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.47 / $580.62 / $611.17
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$570.72 / $570.72 / $606.36
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$570.72 / $570.72 / $723.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$513.07 / $663.97 / $934.77