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South Dakota rates for HCPCS 19396

Preparation Moulage Custom Breast Implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.72 / $271.81 / $271.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.84 / $232.08 / $416.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.87 / $449.72 / $773.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.88 / $322.88 / $744.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.67 / $769.27 / $2,056.57
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$330.34 / $545.73 / $2,596.73
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.36 / $438.00 / $745.05
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.03 / $389.22 / $522.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.67 / $532.66 / $803.71
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.50 / $312.60 / $585.40