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Wisconsin rates for HCPCS 19370

Revision Peri-Implant Capsule Breast

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$558.27 / $1,375.58 / $14,482.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$0.96 / $4,665.64 / $15,793.06
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,060.00 / $8,139.00 / $11,136.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.36 / $2,030.24 / $3,274.71
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$558.27 / $857.54 / $1,793.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$672.51 / $4,017.00 / $12,216.00
Medica
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,803.73 / $2,803.73 / $2,803.73
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$558.27 / $923.93 / $1,793.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,329.25 / $1,888.17 / $2,417.80
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,723.79 / $8,723.79 / $8,723.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,241.00 / $9,837.00 / $12,062.00