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.
Original text from hospital filings
1221603 - EXPANDER TISS 600 CC SUT TAB INTGR INJECTION DOME MENTOR-â¬â+âÃ
Downers Grove, IL
See all hospitals reporting HCPCS C1789 →Price type
Advocate Good Samaritan Hospital’s median price of $2.6k is 29% above the median hospital's median price ($2.1k), higher than 66% of the 1,315 hospitals reporting HCPCS C1789. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 5 payers, 12 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | ||||
|---|---|---|---|---|
| 1 | Blue Cross Blue Shield commercial percent of total billed charges · outpatientfrom % of charges | $1,973 | $1,992 | $1,458 – $2,563 |
| 2 | Blue Cross Blue Shield managed care percent of total billed charges · outpatientfrom % of charges | $2,032 | $2,032 | $1,550 – $2,514 |
| 3 | Blue Cross Blue Shield hmo percent of total billed charges · outpatientfrom % of charges | $2,072 | $2,072 | $1,580 – $2,563 |
| 4 | Blue Cross Blue Shield ppo percent of total billed charges · outpatientfrom % of charges | $2,180 | $2,180 | $1,663 – $2,698 |
| 5 | UnitedHealthcare commercial percent of total billed charges · outpatientfrom % of charges | $2,536 | $2,573 | $1,523 – $4,220 |
| 6 | Cigna commercial percent of total billed charges · inpatientfrom % of charges | $2,905 | $2,919 | $2,183 – $3,682 |
| 7 | Cigna commercial percent of total billed charges · outpatientfrom % of charges | $2,905 | $2,919 | $2,183 – $3,682 |
| 8 | Aetna commercial percent of total billed charges · inpatientfrom % of charges | $3,031 | $3,031 | $2,312 – $3,751 |
| 9 | Aetna commercial percent of total billed charges · outpatientfrom % of charges | $3,031 | $3,031 | $2,312 – $3,751 |
| 10 | UnitedHealthcare hmo percent of total billed charges · outpatientfrom % of charges | $3,949 | $3,949 | $3,012 – $4,886 |
| 11 | MultiPlan commercial percent of total billed charges · inpatientfrom % of charges | $4,578 | $4,578 | $3,492 – $5,665 |
| 12 | MultiPlan commercial percent of total billed charges · outpatientfrom % of charges | $4,578 | $4,578 | $3,492 – $5,665 |
Last updated: Nov 4, 2025
See Smooth low-profile rectangular tissue expander, 160-320 cc pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.