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Utah rates for HCPCS 19371

Peri-implant capsulectomy, breast, complete, including removal of all intracapsular contents

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $7,079.46 / $16,218.10
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$3,548.13 / $12,302.69 / $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
$933.25 / $1,148.15 / $1,584.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $5,128.61 / $8,317.64