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Nebraska 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
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $8,511.38 / $16,595.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $151.36 / $151.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $199.53 / $269.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $218.78 / $288.40