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South Dakota 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
$618.29 / $618.29 / $2,290.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$12,140.63 / $12,140.63 / $12,140.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$714.00 / $1,011.08 / $1,652.81
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,019.00 / $1,702.63 / $2,691.59
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$712.99 / $1,080.55 / $1,271.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00