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Wisconsin rates for HCPCS C2641

Brachytherapy Source Non-Stranded Palladium-103

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.44 / $3.44 / $3.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.44 / $3.44 / $3.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.56 / $119.56 / $119.56
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.44 / $3.44 / $112.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.44 / $3.44 / $203.97
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.44 / $3.44 / $112.20
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.56 / $119.56 / $119.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.97 / $203.97 / $263.01