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Ohio rates for HCPCS 19396

Preparation of moulage for custom breast implant

Facilitymedian $4,169 · 10th–90th $251$10,9650%10%10th90th$4,169Professionalmedian $214 · 10th–90th $123$4790%10%20%10th90th$214$2.0$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$229.09 / $4,265.80 / $10,964.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $229.09 / $912.01
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,698.24 / $3,715.35 / $15,135.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $162.18 / $346.74
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $141.25 / $162.18
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $151.36 / $21,379.62
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $281.84 / $478.63
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21,379.62 / $21,379.62 / $21,379.62
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $281.84 / $489.78
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $33.11
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $4,786.30
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $288.40 / $436.52
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,951.21 / $5,754.40 / $9,332.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $229.09 / $446.68