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California rates for HCPCS C2634

Brachytherapy source, nonstranded, high activity, iodine-125, greater than 1.01 mCi (NIST), per source

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$304.11 / $304.11 / $4,620.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.22 / $212.83 / $304.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.71 / $107.42 / $476.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.93 / $393.93 / $393.93
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $909.55
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $85.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.22 / $304.11 / $435.58
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,250,000.00 / $2,250,000.00 / $2,250,000.00