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Pennsylvania rates for HCPCS 19330

Removal of ruptured breast implant, including implant contents (eg, saline, silicone gel)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$641.00 / $2,422.00 / $7,799.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$770.50 / $770.50 / $1,926.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,800.00 / $7,463.00 / $11,048.00
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,294.82 / $2,294.82 / $2,294.82
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$8,088.42 / $8,088.42 / $8,088.42
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$657.00 / $2,070.00 / $8,017.00
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$770.50 / $770.50 / $1,926.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.19 / $631.95 / $631.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $3,475.00 / $6,000.00