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South Carolina rates for HCPCS 19396

Preparation Moulage Custom Breast Implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.21 / $771.99 / $16,467.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.78 / $224.81 / $392.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,426.16 / $8,615.24 / $13,592.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.18 / $240.00 / $351.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,956.98 / $1,956.98 / $2,514.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.06 / $273.25 / $568.27
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.21 / $299.30 / $523.85
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,512.64 / $1,731.45 / $1,899.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.46 / $299.31 / $460.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $12,798.00 / $19,665.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.04 / $304.98 / $672.93