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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
$30.20 / $30.20 / $30.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $223.87 / $234.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $53,703.18
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $758.58 / $1,288.25
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50,118.72 / $53,703.18 / $75,857.76