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Wisconsin rates for HCPCS 19396

Preparation of moulage for custom breast implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $288.40 / $6,456.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $229.09 / $436.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,317.64 / $13,182.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $446.68 / $977.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $851.14 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $416.87 / $812.83
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $416.87 / $6,918.31
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $467.74 / $794.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $549.54 / $11,481.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $524.81 / $2,041.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $371.54
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $446.68 / $954.99
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,888.44 / $8,709.64 / $8,709.64
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $660.69 / $2,137.96
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $257.04 / $524.81
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $588.84 / $1,148.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,232.93 / $13,182.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $354.81 / $977.24