Smooth low-profile rectangular tissue expander, 160-320 cc

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

IMPLANT-BREAST SILICONE-GEL STYLE-410LX LOW-HEIGHT-EXTRA-FULL-PROJECTION-PROFILE TEXTURED STERILE HIGHLY-COHESIVE GUMMY-BEAR-TYPE 405CC

Payers reporting HCPCS C1789

63 payers file a negotiated rate for this code. Each is shown once, under the terms the most hospitals file it under; rates under different terms (billing class, payment method, setting) are never blended, so open a payer to see them all. Figures are hospital-level averages; the median is across hospitals.

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1	UnitedHealthcare fee schedule · outpatient · +21 other terms	106	$1,657	$1,635	$0.01 – $74,151
2	MultiPlan fee schedule · outpatient · +14 other terms	82	$2,459	$4,155	$0.01 – $22,816
3	Cigna fee schedule · outpatient · +21 other terms	64	$2,365	$2,700	$0.01 – $17,732
4	Aetna fee schedule · inpatient · +24 other terms	61	$2,889	$3,041	$0.01 – $77,157
5	Blue Cross Blue Shield fee schedule · outpatient · +24 other terms	49	$2,153	$2,018	$0.01 – $22,816
6	Humana fee schedule · outpatient · +18 other terms	45	$1,290	$3,128	$0.01 – $16,433
7	Medcost percent of total billed charges · bothfrom % of charges · +5 other terms	38	$4,209	$3,143	$263.29 – $22,370
8	Medical Mutual facility · percent of total billed charges · bothfrom % of charges · +3 other terms	38	$2,094	$1,743	$2.66 – $6,847
9	Anthem fee schedule · outpatient · +18 other terms	31	$1,483	$1,942	$48.20 – $7,945
10	First Health fee schedule · outpatient · +14 other terms	31	$3,129	$3,805	$0.01 – $14,944
11	Kaiser fee schedule · outpatient · +15 other terms	30	$1,944	$1,367	$0.01 – $10,942
12	Baylor Scott White Health Plan facility · percent of total billed charges · inpatientfrom % of charges · +1 other terms	26	$2,587	$2,297	$132.06 – $12,134
13	Molina fee schedule · outpatient · +17 other terms	26	$660.10	$1,537	$0.01 – $40,737
14	Amerihealth Caritas other · outpatient · +6 other terms	25	$772.66	$824.27	$0.95 – $8,372
15	Phcs fee schedule · inpatient · +11 other terms	25	$6,769	$5,111	$0.01 – $21,170
16	Beechstreet percent of total billed charges · bothfrom % of charges · +3 other terms	21	$2,803	$4,462	$301.88 – $14,990
17	Ambetter other · outpatient · +9 other terms	20	$8,047	$10,338	$63.81 – $46,860
18	Medica fee schedule · outpatient · +8 other terms	20	$1,842	$1,972	$27.72 – $5,670
19	Aetna Better Health other · outpatient · +8 other terms	19	$598.96	$807.99	$0.95 – $7,550
20	Bcbs La fee schedule · outpatient · +2 other terms	19	$0.02	$0.02	$0.01 – $0.03
21	Healthcare Highways percent of total billed charges · outpatientfrom % of charges · +3 other terms	18	$4,894	$5,099	$4.39 – $17,084
22	Medicaid fee schedule · outpatient · +12 other terms	18	$181.38	$135.00	$0.12 – $15,000
23	Bcbs Az facility · fee schedule · outpatient · +1 other terms	16	$3,347	$3,356	$1,255 – $4,438
24	Caresource facility · case rate · outpatient · +13 other terms	15	$185.44	$199.11	$123.79 – $314.56
25	WellCare other · outpatient · +7 other terms	15	$1,623	$1,470	$13.13 – $8,289

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