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Wisconsin 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
$537.03 / $1,905.46 / $9,120.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,317.64 / $13,182.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $1,949.84 / $3,090.30
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $2,398.83 / $4,786.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $6,918.31 / $12,302.69
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,513.56 / $2,089.30
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,888.44 / $8,709.64 / $8,709.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,232.93 / $13,182.57