| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $57.75 | $57.75 | $72.19 | |
Medica
| Facility | $100.00 | $146.91 | $146.91 | |
Medica
| Professional | $194.36 | $194.36 | $194.36 | |
United
| Facility | $30.00 | $30.00 | $30.00 |
Breast Prosthesis Mastectomy Sleeve (Special Coverage Instructions Apply. See Mcm: 2130 A)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $57.75 | $57.75 | $72.19 | |
Medica
| Facility | $100.00 | $146.91 | $146.91 | |
Medica
| Professional | $194.36 | $194.36 | $194.36 | |
United
| Facility | $30.00 | $30.00 | $30.00 |