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Wisconsin rates for HCPCS C2642

Brachytherapy Source Stranded Cesium-131 Per Source

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.00 / $88.00 / $88.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.00 / $88.00 / $160.75
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.27 / $88.00 / $89.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.27 / $88.00 / $275.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.00 / $88.00 / $89.28