go back

New Hampshire rates for HCPCS G0458

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $36.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.50 / $233.50 / $233.50
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $2,750.00 / $3,500.00