| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $46.77 | $46.77 | $46.77 | |
Aetna
| Professional | $46.77 | $46.77 | $776.25 | |
Medica
| Facility | $46.77 | $46.77 | $100.00 |
Breast prosthesis, not otherwise specified
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $46.77 | $46.77 | $46.77 | |
Aetna
| Professional | $46.77 | $46.77 | $776.25 | |
Medica
| Facility | $46.77 | $46.77 | $100.00 |