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Missouri 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
$795.10 / $4,261.00 / $12,237.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$611.57 / $2,183.50 / $3,589.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,224.00 / $4,643.00 / $17,951.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,488.00 / $13,882.00 / $15,775.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$577.14 / $1,174.17 / $12,067.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,748.00 / $3,527.00 / $6,944.00