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
EXPANDER TISSUE CPX4 CONTOUR PROFILE SILTEX P6.6 CM MEDIUM HEIGHT W11.7 CM X H10 CM 350 CC BREAST STYLE 9200 SUTURE TAB INTEGRAL INJECTION DOME SELF SEAL PATCH
Quitman, TX
See all hospitals reporting HCPCS C1789 →Price type
Quitman Hospital, LLC’s median price of $944 is 54% below the median hospital's median price ($2.1k), higher than 15% 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: 10 payers, 29 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 blue cross medicare advantage oos [116005] facility · percent of total billed charges · bothfrom % of charges | $396.90 | $446.77 | $210.00 – $873.60 |
| 2 | Cigna cigna medicare replacement [126500] facility · percent of total billed charges · bothfrom % of charges | $396.90 | $446.77 | $210.00 – $873.60 |
| 3 | Humana humana medicare advantage/ppo/gold [152503] facility · percent of total billed charges · bothfrom % of charges | $396.90 | $446.77 | $210.00 – $873.60 |
| 4 | Medicare medicare part a and b [163500] facility · percent of total billed charges · bothfrom % of charges | $396.90 | $446.77 | $210.00 – $873.60 |
| 5 | Medicare medicare part a only [163502] facility · percent of total billed charges · bothfrom % of charges | $396.90 | $446.77 | $210.00 – $873.60 |
| 6 | Medicare medicare part b only [163501] facility · percent of total billed charges · bothfrom % of charges | $396.90 | $446.77 | $210.00 – $873.60 |
| 7 | WellCare wellcare medicare [377501] facility · percent of total billed charges · bothfrom % of charges | $396.90 | $446.77 | $210.00 – $873.60 |
| 8 | Aetna aetna coventry medicare replacement [102002] facility · percent of total billed charges · bothfrom % of charges | $404.84 | $455.71 | $214.20 – $891.07 |
| 9 | UnitedHealthcare uhc medicare advantage [206511] facility · percent of total billed charges · bothfrom % of charges | $404.84 | $455.71 | $214.20 – $891.07 |
| 10 | Ambetter ambetter [293000] facility · percent of total billed charges · bothfrom % of charges | $453.60 | $510.60 | $240.00 – $998.40 |
| 11 | Healthcare Highways hch 90 degree benefits [221013] facility · percent of total billed charges · bothfrom % of charges | $708.75 | $797.81 | $375.00 – $1,560 |
| 12 | Healthcare Highways hch broken arrow [221012] facility · percent of total billed charges · bothfrom % of charges | $708.75 | $797.81 | $375.00 – $1,560 |
| 13 | Healthcare Highways hch john soules foods [221011] facility · percent of total billed charges · bothfrom % of charges | $708.75 | $797.81 | $375.00 – $1,560 |
| 14 | Blue Cross Blue Shield bcbs medicaid [116504] facility · percent of total billed charges · bothfrom % of charges | $944.06 | $1,063 | $499.50 – $2,078 |
| 15 | Cigna cigna healthspring medicaid replacement [394500] facility · percent of total billed charges · bothfrom % of charges | $944.06 | $1,063 | $499.50 – $2,078 |
| 16 | UnitedHealthcare uhc medicaid community plan [375501] facility · percent of total billed charges · bothfrom % of charges | $944.06 | $1,063 | $499.50 – $2,078 |
| 17 | Blue Cross Blue Shield blue cross advantage hmo of texas [115525] facility · percent of total billed charges · bothfrom % of charges | $958.23 | $1,079 | $507.00 – $2,109 |
| 18 | UnitedHealthcare uhc medica choice [206030] facility · percent of total billed charges · bothfrom % of charges | $1,418 | $1,596 | $750.00 – $3,120 |
| 19 | UnitedHealthcare united healthcare student svc [206012] facility · percent of total billed charges · bothfrom % of charges | $1,418 | $1,596 | $750.00 – $3,120 |
| 20 | UnitedHealthcare united healthcare texas exchange plan [206034] facility · percent of total billed charges · bothfrom % of charges | $1,418 | $1,596 | $750.00 – $3,120 |
| 21 | Blue Cross Blue Shield blue cross hmo of texas [115504] facility · percent of total billed charges · bothfrom % of charges | $1,653 | $1,723 | $1,653 – $1,828 |
| 22 | Cigna cigna ppo [126025] facility · percent of total billed charges · bothfrom % of charges | $1,613 | $1,816 | $853.50 – $3,551 |
| 23 | Cigna cigna - great west [126009] facility · percent of total billed charges · bothfrom % of charges | $1,899 | $2,138 | $1,005 – $4,181 |
| 24 | Humana humana commercial [214001] facility · percent of total billed charges · bothfrom % of charges | $1,899 | $2,138 | $1,005 – $4,181 |
| 25 | Phcs phcs multiplan [178000] facility · percent of total billed charges · bothfrom % of charges | $1,899 | $2,138 | $1,005 – $4,181 |
Last updated: Feb 12, 2026
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