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Implantable Breast Prosthesis

Wisconsin rates for HCPCS C1789

Prosthesis, breast (implantable)

Rates data updated July 2026.

Facilitymedian $3,715 · 10th–90th $398$5,4950%10%10th90th$3,715Professionalmedian $398 · 10th–90th $398$2,9510%50%90th$398$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$2,511.89
Median
$4,073.80
Typical High
$5,623.41
Aetna
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$2,951.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$954.99
Typical High
$954.99
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$724.44
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$4,265.80
Median
$4,570.88
Typical High
$5,888.44
Medica
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$602.56
Typical High
$2,137.96
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$60.26
Typical High
$70.79
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$724.44
Quartz
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$104.71
Typical High
$1,862.09
Quartz
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$954.99
Typical High
$954.99