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Wisconsin rates for HCPCS 19371

Peri-Implant Capsulectomy Breast Complete

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$591.75 / $1,456.29 / $14,482.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$9,536.62 / $9,536.62 / $9,536.62
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
$1,835.58 / $2,145.02 / $3,459.84
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$591.75 / $908.99 / $2,103.57
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$711.96 / $2,478.08 / $11,598.00
Medica
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$6,472.62 / $6,472.62 / $6,472.62
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$591.75 / $908.99 / $2,103.57
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,409.85 / $2,155.94 / $2,564.41
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