| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $46.77 | $46.77 | $56.23 | |
Providence
| Facility | $46.77 | $52.48 | $776.25 | |
Providence
| Professional | $60.26 | $79.43 | $85.11 |
Breast prosthesis, not otherwise specified
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $46.77 | $46.77 | $56.23 | |
Providence
| Facility | $46.77 | $52.48 | $776.25 | |
Providence
| Professional | $60.26 | $79.43 | $85.11 |