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Montana rates for HCPCS 19396

Preparation Moulage Custom Breast Implant

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.53 / $757.41 / $1,536.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$224.52 / $224.52 / $224.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.50 / $243.86 / $482.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$139.13 / $388.05 / $442.12
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.21 / $290.56 / $482.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.08 / $475.59 / $763.13