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Arizona rates for HCPCS G0458

Low dose rate (LDR) prostate brachytherapy services, composite rate

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $1,500.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,283.75 / $8,400.00 / $13,739.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,172.54 / $1,563.38 / $1,954.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.00 / $1,500.00 / $3,045.00