| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $23.66 | $27.70 | $38.86 | |
Cigna
| Facility | $28.50 | $28.50 | $28.50 | |
Cigna
| Professional | $20.81 | $20.81 | $33.58 | |
United
| Professional | $14.21 | $21.32 | $35.53 |
For Diabetics Only Modification (Including Fitting) Of Off-The- Shelf Depth-Inlay Shoe Or Custom-Molded Shoe With Metatarsal Bar Per Shoe (Special Coverage Instructions Apply. See Mcm: 2134)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $23.66 | $27.70 | $38.86 | |
Cigna
| Facility | $28.50 | $28.50 | $28.50 | |
Cigna
| Professional | $20.81 | $20.81 | $33.58 | |
United
| Professional | $14.21 | $21.32 | $35.53 |