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Washington rates for HCPCS 19396

Preparation of moulage for custom breast implant

Facilitymedian $661 · 10th–90th $269$16,2180%5%10th90th$661Professionalmedian $288 · 10th–90th $126$6920%5%10%10th90th$288$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
$288.40 / $794.33 / $18,620.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $239.88 / $630.96
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,918.31 / $10,232.93 / $20,892.96
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $380.19 / $645.65
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,187.76 / $2,187.76 / $3,630.78
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $398.11 / $776.25
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $457.09 / $3,801.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $398.11 / $891.25
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $33.11
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $524.81 / $562.34
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$371.54 / $371.54 / $371.54
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $371.54 / $676.08
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,079.46 / $10,471.29 / $20,892.96
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $380.19 / $645.65
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,467.37 / $12,302.69 / $22,387.21
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $331.13 / $676.08
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $263.03 / $426.58