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Montana rates for HCPCS C1789

Prothesis, breast (implantable)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,026.00 / $6,614.28 / $8,207.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,972.50 / $4,972.50 / $4,972.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.93 / $1,054.93 / $1,054.93
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$402.32 / $402.32 / $402.32
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.93 / $1,800,000.00 / $2,400,000.00