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Pennsylvania 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
$588.84 / $588.84 / $588.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $602.56 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $1,905.46 / $3,162.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $524.81
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $912.01 / $912.01
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $794.33 / $831.76
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $588.84 / $588.84
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $588.84 / $741.31
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $1,819.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,995.26 / $2,454.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $707.95 / $1,174.90