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Maine rates for HCPCS G0458

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $1,513.56
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $234.42 / $257.04
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $1,513.56