go back

Montana 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 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,697.58 / $1,697.58 / $1,697.58
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,697.58 / $1,697.58 / $1,697.58