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Wisconsin rates for HCPCS C2616

Brachytherapy Source Non-Stranded Yttrium-90 Per Source

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,821.91 / $30,195.00 / $47,965.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,821.91 / $15,821.91 / $19,968.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62,908.09 / $73,513.08 / $112,770.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,087.50 / $30,523.87 / $34,686.21
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,497.00 / $15,821.91 / $15,821.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,497.00 / $15,821.91 / $44,708.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25,629.86 / $25,629.86 / $25,629.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,126.71 / $15,821.91 / $15,821.91
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,087.50 / $16,087.50 / $16,087.50