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Idaho rates for HCPCS 19396

Preparation Moulage Custom Breast Implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,897.00 / $4,500.00 / $7,761.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.50 / $231.81 / $419.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.35 / $269.70 / $495.39
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$182.50 / $275.24 / $500.22
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.03 / $278.82 / $522.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $368.65 / $463.79
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,871.35 / $8,752.65 / $11,549.09
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.41 / $264.14 / $510.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,360.00 / $16,762.00 / $17,870.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.50 / $404.74 / $535.12