| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $47.06 | $47.06 | $85.95 | |
Kaiser Permanente
| Professional | $35.00 | $35.00 | $35.00 | |
Wellpoint
| Professional | $2,500.00 | $2,500.00 | $2,500.00 |
Breast prosthesis, not otherwise specified
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $47.06 | $47.06 | $85.95 | |
Kaiser Permanente
| Professional | $35.00 | $35.00 | $35.00 | |
Wellpoint
| Professional | $2,500.00 | $2,500.00 | $2,500.00 |