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Idaho rates for HCPCS G0458

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,500.00 / $1,500.00 / $1,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $1,500.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $38.40 / $54.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $3,500.00 / $3,900.00