| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $14.05 | $17.82 | $17.82 | |
BCBS
| Professional | $75.00 | $75.00 | $75.00 | |
Cigna
| Facility | $10.75 | $10.75 | $10.75 | |
Cigna
| Professional | $7.85 | $7.85 | $10.75 |
Non-Standard Size Or Width (Special Coverage Instructions Apply. See Mcm: 2323)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $14.05 | $17.82 | $17.82 | |
BCBS
| Professional | $75.00 | $75.00 | $75.00 | |
Cigna
| Facility | $10.75 | $10.75 | $10.75 | |
Cigna
| Professional | $7.85 | $7.85 | $10.75 |