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California rates for HCPCS 19301

Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy);

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.23 / $7,585.78 / $17,782.79
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$4,570.88 / $10,000.00 / $19,952.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $831.76 / $2,691.53
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,230.27 / $1,548.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $7,943.28 / $15,848.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $870.96 / $1,949.84
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $3,890.45 / $10,000.00
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $707.95 / $1,584.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $1,949.84 / $2,290.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $776.25 / $1,659.59
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $707.95 / $954.99
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $776.25 / $1,479.11
Kaiser Permanente
Facility/Professional
Professional
Modifier
80
Low / Median / High Price
$501.19 / $501.19 / $501.19
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $45,708.82 / $45,708.82
Lucent Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$870.96 / $870.96 / $870.96
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,677.35 / $5,754.40 / $5,754.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $977.24 / $977.24
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $812.83 / $1,288.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $776.25 / $1,698.24
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,089.30
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $562.34 / $645.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $7,585.78 / $15,135.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $707.95 / $1,862.09