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California rates for HCPCS 19396

Preparation Moulage Custom Breast Implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.32 / $6,423.00 / $17,538.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.04 / $224.81 / $1,150.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,629.00 / $7,028.00 / $15,328.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.44 / $262.02 / $671.92
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.00 / $100.00 / $12,654.53
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.31 / $185.51 / $439.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,943.01 / $2,296.29 / $5,409.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.83 / $286.79 / $786.99
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.31 / $258.23 / $435.36
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.08 / $277.23 / $493.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$492.71 / $709.79 / $5,897.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,186.00 / $2,056.57 / $2,275.94
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.00 / $277.23 / $422.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.08 / $307.00 / $729.58
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$469.95 / $469.95 / $953.21
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.11 / $279.75 / $387.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,728.00 / $9,759.00 / $22,073.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.88 / $319.58 / $1,003.80