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South Dakota rates for HCPCS 19396

Preparation of moulage for custom breast implant

Facilitymedian $269 · 10th–90th $135–$4,3650%10%20%10th90th$269Professionalmedian $263 · 10th–90th $126–$5500%10%10th90th$263$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $269.15 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $234.42 / $389.05
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $407.38 / $794.33
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $331.13 / $741.31
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $549.54 / $2,041.74
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $331.13 / $660.69
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $302.00 / $588.84
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $380.19 / $524.81
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,162.28 / $3,162.28 / $7,943.28
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $354.81 / $741.31
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $309.03 / $588.84