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New Hampshire 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
$667.85 / $667.85 / $740.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.25 / $609.91 / $609.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,121.17 / $4,313.91 / $5,844.26
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$778.68 / $1,486.61 / $2,769.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.08 / $841.99 / $2,385.94
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $2,750.00 / $3,500.00