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Maine 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
$1,245.00 / $1,377.84 / $5,778.35
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,274.35 / $2,274.35 / $15,138.99
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,245.00 / $1,377.84 / $5,778.35
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,274.35 / $9,849.92 / $15,138.99