| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $61.22 | $61.22 | $73.34 | |
Molina
| Professional | $50.00 | $60.00 | $70.00 | |
Providence
| Professional | $2,400,000.00 | $2,400,000.00 | $2,400,000.00 |
Breast prosthesis, mastectomy sleeve
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $61.22 | $61.22 | $73.34 | |
Molina
| Professional | $50.00 | $60.00 | $70.00 | |
Providence
| Professional | $2,400,000.00 | $2,400,000.00 | $2,400,000.00 |