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Indiana rates for HCPCS C1789

Prosthesis, breast (implantable)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,799.72 / $9,633.12 / $19,266.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.32 / $402.32 / $4,972.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.01 / $20.01 / $20.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.93 / $1,054.93 / $1,054.93