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Indiana 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
$104.71 / $104.71 / $104.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $104.71 / $213.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $602.56 / $691.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $213.80 / $213.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $128.82 / $128.82