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Utah rates for HCPCS C2640

Brachytherapy source, stranded, palladium-103, per source

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $138.04 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.13 / $14.13 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $131.83 / $131.83
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $169.82 / $371.54
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $69.18 / $69.18