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New Mexico rates for HCPCS 19396

Preparation of moulage for custom breast implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$272.22 / $7,838.38 / $8,763.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.69 / $215.61 / $424.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.47 / $272.33 / $483.47
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $227.61 / $402.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$233.83 / $305.14 / $388.37
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.13 / $272.33 / $507.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,602.00 / $9,127.00 / $10,150.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.06 / $401.79 / $706.27