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West Virginia 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 / $616.60 / $724.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $977.24 / $977.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,311.31 / $3,311.31 / $3,311.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $1,949.84 / $1,949.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $537.03 / $1,000.00