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Wisconsin rates for HCPCS G0458

Ldr prostate brachy comp rat

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 / $1,500.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.80 / $331.57 / $331.57
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $37.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $1,500.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $50.00 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $37.50