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Wisconsin 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
$49.81 / $51.12 / $51.12
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.12 / $51.12 / $604.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.12 / $51.12 / $604.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.12 / $51.12 / $604.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.50 / $55.50 / $55.50