| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $57.75 | $58.33 | $73.34 | |
Medica
| Facility | $146.91 | $146.91 | $146.91 | |
Medica
| Professional | $194.36 | $194.36 | $194.36 |
Breast prosthesis, mastectomy sleeve
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $57.75 | $58.33 | $73.34 | |
Medica
| Facility | $146.91 | $146.91 | $146.91 | |
Medica
| Professional | $194.36 | $194.36 | $194.36 |