| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $8,458.10 | $8,458.10 | $8,458.10 | |
Priority Health
| Facility | $8,458.10 | $8,458.10 | $8,458.10 |
Level 4 Extraocular, Repair, and Plastic Eye Procedures
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $8,458.10 | $8,458.10 | $8,458.10 | |
Priority Health
| Facility | $8,458.10 | $8,458.10 | $8,458.10 |