| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $25.00 | $25.00 | $25.00 | |
Cigna
| Facility | $32.74 | $32.74 | $32.74 | |
Cigna
| Professional | $23.90 | $23.90 | $32.74 |
For Diabetics Only Direct Formed Compression Molded To Patients Foot Without External Heat Source Multiple-Density Insert(S) Prefabricated Per Shoe (Special Coverage Instructions Apply. See Mcm: 2134)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $25.00 | $25.00 | $25.00 | |
Cigna
| Facility | $32.74 | $32.74 | $32.74 | |
Cigna
| Professional | $23.90 | $23.90 | $32.74 |