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North Dakota 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
$456.15 / $456.15 / $456.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.76 / $456.15 / $653.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,046.49 / $1,100.83 / $1,488.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.82 / $775.46 / $1,116.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$631.79 / $1,138.32 / $4,140.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$631.79 / $1,070.54 / $1,638.90