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New Hampshire rates for HCPCS 19396

Preparation Moulage Custom Breast Implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $478.46 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.11 / $219.19 / $472.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,302.10 / $3,669.21 / $6,000.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.00 / $269.63 / $470.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.41 / $428.87 / $829.15
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.85 / $438.77 / $922.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,949.00 / $9,949.00 / $9,949.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$304.47 / $468.17 / $990.11
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.06 / $159.68 / $276.70