go back

Washington 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
$916.92 / $5,128.00 / $20,680.40
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$13,512.18 / $16,971.41 / $31,446.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,520.82 / $10,802.03 / $26,542.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$10,735.34 / $16,203.05 / $31,346.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,186.71 / $2,186.71 / $3,643.05
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$960.63 / $1,684.65 / $8,528.74
Kaiser Permanente
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$8,528.74 / $9,505.52 / $22,870.24
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,092.06 / $1,399.04 / $1,524.92
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.02 / $979.35 / $1,239.50
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,156.89 / $10,795.86 / $20,663.07
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$10,735.34 / $16,193.79 / $30,994.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $3,297.00 / $12,835.00