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Montana 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
$457.09 / $707.95 / $1,096.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,000.00
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,122.02 / $2,187.76
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,122.02 / $2,187.76
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $630.96 / $1,202.26
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,096.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $812.83 / $1,122.02