| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $57.75 | $57.75 | $72.19 | |
Medcost
| Facility | $26.15 | $31.28 | $62.60 | |
Medcost
| Professional | $42.00 | $42.00 | $45.00 | |
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 |
|---|---|---|---|---|---|
Cigna
| Professional | $57.75 | $57.75 | $72.19 | |
Medcost
| Facility | $26.15 | $31.28 | $62.60 | |
Medcost
| Professional | $42.00 | $42.00 | $45.00 | |
United
| Facility | $30.00 | $30.00 | $30.00 |