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Oklahoma rates for HCPCS 19396

Preparation of moulage for custom breast implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $3,742.00 / $12,600.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.40 / $273.33 / $275.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.12 / $222.80 / $371.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.83 / $230.89 / $402.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.52 / $319.54 / $5,882.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.95 / $399.17 / $2,056.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,157.00 / $4,054.00 / $7,077.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.95 / $295.93 / $458.69