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Wisconsin rates for HCPCS C2640

Brachytherapy Source Stranded Palladium-103

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.82 / $14.82 / $14.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.82 / $14.82 / $144.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.77 / $130.77 / $130.77
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.82 / $14.82 / $72.65
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.82 / $14.82 / $178.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.82 / $14.82 / $72.65
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.77 / $130.77 / $130.77