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Indiana rates for HCPCS 19370

Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial capsulectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.46 / $3,246.65 / $17,945.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,852.43 / $8,224.39 / $9,717.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,536.00 / $8,512.00 / $16,615.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$669.90 / $913.50 / $1,370.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,061.25 / $2,061.25 / $2,061.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,932.00 / $8,025.00 / $11,038.00