| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $57.75 | $58.33 | $72.19 | |
Molina
| Professional | $68.04 | $68.04 | $74.37 | |
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 | $58.33 | $72.19 | |
Molina
| Professional | $68.04 | $68.04 | $74.37 | |
United
| Facility | $30.00 | $30.00 | $30.00 |