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Utah rates for HCPCS C1789

Prosthesis, breast (implantable)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$402.32 / $6,022.64 / $6,602.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.32 / $402.32 / $4,972.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.93 / $1,054.93 / $1,054.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $45.00