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Minnesota 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
$643.15 / $975.04 / $6,575.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$5,965.00 / $8,589.00 / $13,527.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.72 / $6,631.62 / $14,092.16
BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$8,691.53 / $13,186.96 / $23,122.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,623.89 / $2,302.87 / $5,539.87
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,320.10 / $2,105.38 / $4,362.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$841.39 / $1,356.09 / $9,232.98
Medica
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$329.93 / $3,009.00 / $4,553.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,293.00 / $6,652.00 / $9,810.00