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Utah 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
$1,862.09 / $6,918.31 / $10,232.93
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,511.89 / $7,413.10 / $12,302.69
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,248.07 / $6,165.95 / $14,454.40
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$7,762.47 / $9,120.11 / $21,877.62
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,071.52 / $1,479.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $5,128.61 / $8,317.64