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Indiana rates for HCPCS 19396

Preparation Moulage Custom Breast Implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.32 / $406.68 / $11,093.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.32 / $222.96 / $253.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,614.00 / $10,300.00 / $21,000.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.63 / $232.04 / $365.78
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.63 / $250.58 / $298.77
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.50 / $433.16 / $451.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,061.25 / $2,061.25 / $2,061.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.08 / $263.08 / $555.39
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,932.00 / $8,025.00 / $11,038.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.98 / $309.89 / $498.54