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New Mexico rates for HCPCS G0458

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $1,513.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $60.26 / $85.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $107.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $41.69 / $41.69