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Utah rates for HCPCS 19396

Preparation of moulage for custom breast implant

Facilitymedian $5,495 · 10th–90th $251–$8,9130%10%10th90th$5,495Professionalmedian $234 · 10th–90th $132–$4370%10%10th90th$234$50.0$200.0$1.0K$5.0K

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
$251.19 / $4,570.88 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $229.09 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $269.15 / $478.63
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $302.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,495.41 / $7,585.78 / $11,481.54
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $323.59 / $588.84
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $302.00 / $691.83
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $363.08 / $512.86
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $5,128.61 / $8,317.64
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $245.47 / $489.78