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Maryland rates for HCPCS 19396

Preparation Moulage Custom Breast Implant

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.78 / $249.46 / $757.41
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.68 / $129.68 / $172.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.87 / $1,621.87 / $1,621.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.94 / $289.32 / $623.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.24 / $372.72 / $638.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.91 / $321.58 / $581.27
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.19 / $322.27 / $396.59