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Utah 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
$2,238.72 / $3,388.44 / $4,570.88
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$17,782.79 / $17,782.79 / $17,782.79
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,248.07 / $6,165.95 / $14,454.40
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$7,762.47 / $9,120.11 / $21,877.62
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,047.13 / $1,445.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $5,128.61 / $8,317.64