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South Dakota rates for HCPCS C1789

Prosthesis, breast (implantable)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$402.32 / $3,738.49 / $12,429.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.32 / $3,306.43 / $4,972.50
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
$679.92 / $5,587.87 / $9,059.62