| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $79.98 | $86.76 | $90.65 | |
Cigna
| Facility | $120.62 | $120.62 | $120.62 | |
Cigna
| Professional | $88.05 | $88.05 | $120.62 | |
United
| Professional | $86.91 | $96.97 | $133.71 |
Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $79.98 | $86.76 | $90.65 | |
Cigna
| Facility | $120.62 | $120.62 | $120.62 | |
Cigna
| Professional | $88.05 | $88.05 | $120.62 | |
United
| Professional | $86.91 | $96.97 | $133.71 |