| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $1.27 | $2.27 | $4.12 | |
Cigna
| Professional | $1.77 | $1.77 | $7.69 | |
MVP Health Care
| Professional | $1.77 | $1.77 | $7.69 | |
United
| Professional | $1.44 | $3.25 | $5.00 |
Mouth Piece (Special Coverage Instructions Apply. See Cim: 60-4 And Mcm: 3312)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $1.27 | $2.27 | $4.12 | |
Cigna
| Professional | $1.77 | $1.77 | $7.69 | |
MVP Health Care
| Professional | $1.77 | $1.77 | $7.69 | |
United
| Professional | $1.44 | $3.25 | $5.00 |