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North Carolina 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
$630.96 / $630.96 / $1,380.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $630.96 / $776.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,288.25 / $1,862.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $691.83 / $977.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,311.31 / $3,311.31 / $3,311.31
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $660.69 / $1,202.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $524.81 / $524.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $812.83 / $1,513.56
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,365.16 / $4,365.16 / $4,365.16
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,168.69 / $5,370.32 / $5,370.32