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Louisiana rates for HCPCS 19396

Preparation Moulage Custom Breast Implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$307.85 / $1,850.00 / $3,884.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.18 / $195.96 / $340.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,987.44 / $6,055.77 / $8,973.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.40 / $250.29 / $325.62
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.22 / $266.07 / $462.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$882.00 / $3,238.00 / $8,257.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.76 / $329.84 / $565.53