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Pennsylvania rates for HCPCS C1789

Prosthesis, breast (implantable)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$712.60 / $3,845.60 / $9,667.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.32 / $402.32 / $3,306.43
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36,666.68 / $57,632.33 / $98,566.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.93 / $1,054.93 / $1,054.93
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$975.41 / $1,314.24 / $2,511.13
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36,666.68 / $46,453.74 / $98,566.36
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$945.61 / $2,949.75 / $9,667.84
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.32 / $402.32 / $3,306.43
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.93 / $1,054.93 / $1,054.93