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Pennsylvania 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
$226.21 / $538.50 / $1,539.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.22 / $226.22 / $395.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.00 / $348.00 / $348.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38,249.62 / $38,249.62 / $38,249.62
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$393.25 / $852.76 / $1,680.78
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.01 / $671.87 / $1,539.16
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.22 / $226.22 / $395.67
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.00 / $348.00 / $348.00