| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $74.83 | $100.90 | $116.39 | |
Cigna
| Facility | $56.50 | $56.50 | $56.50 | |
Cigna
| Professional | $41.25 | $56.50 | $56.50 | |
United
| Professional | $67.58 | $95.08 | $136.66 |
Foot Shoe Molded To Patient Model Plastazote (Or Similar) Custom Fabricated Each (Special Coverage Instructions Apply. See Mcm: 2323)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $74.83 | $100.90 | $116.39 | |
Cigna
| Facility | $56.50 | $56.50 | $56.50 | |
Cigna
| Professional | $41.25 | $56.50 | $56.50 | |
United
| Professional | $67.58 | $95.08 | $136.66 |