| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $14.05 | $14.05 | $14.05 | |
Aetna
| Professional | $14.05 | $14.05 | $14.05 | |
CareFirst
| Professional | $24.52 | $24.52 | $24.52 | |
Cigna
| Professional | $7.85 | $7.85 | $7.85 |
Nonstandard size or width
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $14.05 | $14.05 | $14.05 | |
Aetna
| Professional | $14.05 | $14.05 | $14.05 | |
CareFirst
| Professional | $24.52 | $24.52 | $24.52 | |
Cigna
| Professional | $7.85 | $7.85 | $7.85 |