| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $47.06 | $47.06 | $55.68 | |
Aetna
| Professional | $47.06 | $47.06 | $776.64 | |
Medica
| Facility | $47.06 | $47.06 | $80.00 |
Breast prosthesis, not otherwise specified
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $47.06 | $47.06 | $55.68 | |
Aetna
| Professional | $47.06 | $47.06 | $776.64 | |
Medica
| Facility | $47.06 | $47.06 | $80.00 |