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New Hampshire rates for HCPCS 19396

Preparation of moulage for custom breast implant

Facilitymedian $2,399 · 10th–90th $468–$11,4820%10%10th90th$2,399Professionalmedian $257 · 10th–90th $123–$6030%5%10%10th90th$257$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

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
Facility
Modifier
Typical Low / Median / Typical High
$467.74 / $2,398.83 / $11,481.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $218.78 / $354.81
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,467.37 / $4,677.35 / $6,309.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $288.40 / $501.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $380.19 / $758.58
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10,000.00 / $10,000.00 / $10,000.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $346.74 / $724.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10,000.00 / $10,000.00 / $10,000.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $354.81 / $758.58