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Missouri rates for HCPCS C1789

Prosthesis, breast (implantable)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$402.31 / $2,651.25 / $6,063.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.32 / $402.32 / $402.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.93 / $1,054.93 / $1,054.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$402.32 / $402.32 / $901.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,666.22 / $1,666.22 / $1,666.22