| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $70.08 | $70.08 | $70.08 | |
Medica
| Facility | $100.00 | $100.00 | $100.00 | |
Medica
| Professional | $6.56 | $6.56 | $6.56 |
Miscellaneous Dme Supply Or Accessory Not Otherwise Specified
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $70.08 | $70.08 | $70.08 | |
Medica
| Facility | $100.00 | $100.00 | $100.00 | |
Medica
| Professional | $6.56 | $6.56 | $6.56 |