| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aultcare
| Professional | $48.98 | $48.98 | $48.98 | |
Cigna
| Professional | $57.54 | $57.54 | $72.44 | |
United
| Facility | $15.14 | $28.18 | $45.71 | |
United
| Professional | $10.96 | $16.60 | $25.70 |
Breast prosthesis, mastectomy sleeve
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aultcare
| Professional | $48.98 | $48.98 | $48.98 | |
Cigna
| Professional | $57.54 | $57.54 | $72.44 | |
United
| Facility | $15.14 | $28.18 | $45.71 | |
United
| Professional | $10.96 | $16.60 | $25.70 |