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Arizona rates for HCPCS 19396

Preparation Moulage Custom Breast Implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,965.00 / $3,819.00 / $7,467.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.90 / $231.81 / $757.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$438.60 / $1,640.88 / $2,700.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.48 / $165.61 / $248.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,833.49 / $2,833.49 / $2,833.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.94 / $244.13 / $467.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.29 / $254.99 / $4,571.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.80 / $339.06 / $2,056.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $4,545.00 / $7,217.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.04 / $295.93 / $542.66