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South 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
$653.80 / $653.80 / $653.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$633.41 / $633.41 / $653.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$993.47 / $1,100.83 / $1,100.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219.89 / $909.89 / $1,735.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$558.00 / $1,041.60 / $1,206.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$658.47 / $1,092.71 / $1,420.10
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,046.49 / $1,128.34 / $1,561.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$631.79 / $719.72 / $1,148.72