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Maine rates for HCPCS 19396

Preparation Moulage Custom Breast Implant

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.50 / $145.02 / $230.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.00 / $265.64 / $409.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.54 / $305.25 / $517.92
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.66 / $298.83 / $517.60
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.50 / $121.20 / $230.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.83 / $379.77 / $550.02