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Illinois rates for HCPCS 19396

Preparation Moulage Custom Breast Implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$264.00 / $1,609.00 / $5,405.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.93 / $228.46 / $437.78
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,229.78 / $2,669.18 / $6,506.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.55 / $280.20 / $448.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.00 / $11,310.00 / $14,224.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.54 / $296.74 / $495.67
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.00 / $382.74 / $952.47
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.10 / $181.01 / $362.01
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $417.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,152.00 / $5,000.00 / $8,995.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.11 / $356.10 / $615.16