| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $51.12 | $51.12 | $51.12 | |
Aetna
| Professional | $49.81 | $51.12 | $51.12 | |
Molina
| Professional | $29.11 | $60.00 | $85.00 | |
Providence
| Facility | $43.45 | $43.45 | $43.45 |
Brachytherapy source, nonstranded, high activity, palladium-103, greater than 2.2 mCi (NIST), per source
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $51.12 | $51.12 | $51.12 | |
Aetna
| Professional | $49.81 | $51.12 | $51.12 | |
Molina
| Professional | $29.11 | $60.00 | $85.00 | |
Providence
| Facility | $43.45 | $43.45 | $43.45 |