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Maine rates for HCPCS C1717

Brachytherapy source, nonstranded, high dose rate iridium-192, per source

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$453.83 / $467.26 / $1,193.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.82 / $172.82 / $864.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.00 / $348.00 / $348.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.39 / $342.39 / $342.39
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$453.83 / $467.31 / $4,446.14
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.82 / $172.82 / $864.04