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Montana rates for HCPCS 19396

Preparation of moulage for custom breast implant

Facilitymedian $447 · 10th–90th $245–$8320%20%10th90th$447Professionalmedian $269 · 10th–90th $145–$6760%10%20%10th90th$269$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $251.19 / $676.08
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46,773.51 / $75,857.76 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $223.87 / $223.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $204.17 / $426.58
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $467.74 / $501.19
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $467.74 / $501.19
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $223.87 / $446.68
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $223.87 / $524.81
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$371.54 / $371.54 / $7,943.28
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $363.08 / $575.44