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Utah rates for HCPCS 19396

Preparation Moulage Custom Breast Implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.37 / $3,294.00 / $7,568.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.37 / $249.35 / $390.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.15 / $271.74 / $474.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.41 / $226.93 / $297.65
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,302.41 / $7,227.26 / $10,532.19
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.45 / $320.27 / $520.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $6,097.00 / $8,267.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.36 / $332.80 / $608.39