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Wisconsin rates for HCPCS C2645

Brachytherapy planar source, palladium-103, per sq mm

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.91 / $8.91 / $8.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $12.02 / $12.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $58.88 / $85.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.30 / $12.30 / $16.22