| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $5.00 | $5.00 | $5.00 | |
Cigna
| Facility | $1.19 | $22.55 | $22.55 | |
Cigna
| Professional | $19.17 | $19.17 | $22.55 | |
Martin's Point
| Professional | $5.00 | $5.00 | $5.00 |
Ostomy Supply; Miscellaneous (Special Coverage Instructions Apply. See Mcm: 2130)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $5.00 | $5.00 | $5.00 | |
Cigna
| Facility | $1.19 | $22.55 | $22.55 | |
Cigna
| Professional | $19.17 | $19.17 | $22.55 | |
Martin's Point
| Professional | $5.00 | $5.00 | $5.00 |