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New Hampshire 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
$561.60 / $864.03 / $864.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.00 / $864.04 / $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 / $378.55 / $499.68