| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $11.00 | $15.13 | $15.14 | |
Cigna
| Professional | $0.12 | $0.12 | $0.12 | |
Martin's Point
| Professional | $4.40 | $15.13 | $15.13 |
Orthopedic Shoe Modification Addition Or Transfer Not Otherwise Specified (Special Coverage Instructions Apply. See Mcm: 2323)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $11.00 | $15.13 | $15.14 | |
Cigna
| Professional | $0.12 | $0.12 | $0.12 | |
Martin's Point
| Professional | $4.40 | $15.13 | $15.13 |