| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2.27 | $2.27 | $2.27 | |
Aetna
| Professional | $0.51 | $2.27 | $2.27 | |
Cigna
| Professional | $6.50 | $6.50 | $6.50 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |
Incontinence Supply; Miscellaneous (Special Coverage Instructions Apply. See Mcm: 2130)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2.27 | $2.27 | $2.27 | |
Aetna
| Professional | $0.51 | $2.27 | $2.27 | |
Cigna
| Professional | $6.50 | $6.50 | $6.50 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |