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Wisconsin rates for HCPCS C2638

Brachytherapy Source Stranded Iodine-125 Per Source

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.78 / $27.78 / $27.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.78 / $27.78 / $65.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.96 / $36.96 / $36.96
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.78 / $27.78 / $29.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.78 / $27.78 / $94.71
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.78 / $27.78 / $29.35
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.96 / $36.96 / $36.96