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New York 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 / $30.00
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
$188.55 / $221.82 / $233.50
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$634.00 / $748.00 / $1,211.76
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $597.00 / $74,999.25