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Virginia rates for HCPCS 19301

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$842.52 / $4,782.00 / $8,294.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$3,780.00 / $4,357.50 / $5,982.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$554.91 / $735.43 / $1,313.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,032.00 / $6,548.00 / $7,221.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.50 / $783.25 / $1,081.03
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$706.07 / $991.15 / $5,291.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$491.77 / $843.92 / $1,632.32
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$624.20 / $749.04 / $923.82
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$625.12 / $802.28 / $1,201.42
Medcost
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$606.38 / $1,394.16 / $1,937.80
Medcost
Facility/Professional
Facility
Modifier
80
Low / Median / High Price
$80.84 / $185.89 / $258.37
Medcost
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$56.60 / $130.12 / $180.86
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$744.00 / $912.00 / $1,534.46
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$453.66 / $838.74 / $4,071.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$453.66 / $838.74 / $4,071.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,349.00 / $7,061.00 / $12,739.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$427.88 / $704.37 / $1,429.06