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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
$616.60 / $2,691.53 / $8,317.64
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$776.25 / $776.25 / $1,905.46
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $6,606.93 / $57,543.99
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$8,128.31 / $8,128.31 / $8,128.31
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $2,089.30 / $8,317.64
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$776.25 / $776.25 / $1,905.46
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $645.65 / $1,318.26
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $575.44 / $630.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $3,981.07 / $12,022.64