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Ohio 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
$991.72 / $4,723.00 / $11,581.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$3,292.20 / $7,418.00 / $12,216.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,760.00 / $3,967.00 / $14,996.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$635.72 / $762.86 / $1,013.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $2,808.98 / $2,963.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,840.00 / $5,998.00 / $7,847.00