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Texas rates for HCPCS 19380

Revision of reconstructed breast (eg, significant removal of tissue, re-advancement and/or re-inset of flaps in autologous reconstruction or significant capsular revision combined with soft tissue excision in implant-based reconstruction)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$969.00 / $3,601.00 / $9,340.10
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,692.25 / $5,638.50 / $11,391.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,346.95 / $8,013.05 / $15,711.87
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$685.00 / $2,347.10 / $6,393.56
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$717.26 / $5,355.81 / $5,355.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,850.42 / $3,850.42 / $3,850.42
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,500.00 / $26,542.00 / $26,542.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$748.75 / $954.16 / $1,700.73
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$753.14 / $985.01 / $1,740.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,093.00 / $6,000.00 / $13,134.00