| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Facility | $74.55 | $74.55 | $82.01 | |
BCBS
| Professional | $71.00 | $71.00 | $71.00 | |
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 |
|---|---|---|---|---|---|
BCBS
| Facility | $74.55 | $74.55 | $82.01 | |
BCBS
| Professional | $71.00 | $71.00 | $71.00 | |
United
| Facility | $30.00 | $30.00 | $30.00 |