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Wisconsin rates for HCPCS C2640

Brachytherapy source, stranded, palladium-103, per source

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.13 / $14.13 / $14.13
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
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.79 / $14.79 / $72.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.79 / $14.79 / $446.68
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $58.88 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $131.83 / $131.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $229.09 / $302.00