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Washington rates for HCPCS C2635

Brachytherapy source, nonstranded, high activity, palladium-103, greater than 2.2 mCi (NIST), per source

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.12 / $51.12 / $51.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.12 / $51.12 / $604.41
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.09 / $175.87 / $340.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.25 / $168.25 / $168.25
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.62 / $129.50 / $235.16
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.43 / $33.43 / $33.43
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.22 / $150.00 / $79,999.20
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.09 / $171.97 / $336.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.50 / $55.50 / $59.45