| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $19.57 | $24.00 | $24.00 | |
Cigna
| Facility | $23.72 | $23.72 | $23.72 | |
Cigna
| Professional | $17.32 | $23.72 | $23.72 |
Non-Standard Size Or Length (Special Coverage Instructions Apply. See Mcm: 2323)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $19.57 | $24.00 | $24.00 | |
Cigna
| Facility | $23.72 | $23.72 | $23.72 | |
Cigna
| Professional | $17.32 | $23.72 | $23.72 |