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New Mexico 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
$637.11 / $637.11 / $637.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.14 / $637.11 / $1,084.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.07 / $676.07 / $676.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,058.49 / $1,058.49 / $1,058.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $85.00 / $903.04
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$520.32 / $520.32 / $676.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$701.74 / $705.28 / $1,280.11