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South Dakota rates for HCPCS 19371

Peri-implant capsulectomy, breast, complete, including removal of all intracapsular contents

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $676.08 / $4,365.16
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$6,025.60 / $6,025.60 / $6,025.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $1,148.15 / $3,162.28
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,659.59 / $1,778.28
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,230.27 / $1,412.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28