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Minnesota 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
$653.80 / $653.80 / $653.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.40 / $604.69 / $653.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$878.85 / $1,461.71 / $2,899.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.90 / $211.12 / $211.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$716.56 / $716.56 / $716.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,010.59 / $1,201.25 / $3,277.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$492.81 / $1,101.99 / $1,836.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$746.67 / $1,128.44 / $2,346.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$719.72 / $1,078.50 / $2,153.67