| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,051.59 | $1,051.59 | $1,051.59 | |
Cigna
| Professional | $893.86 | $893.86 | $1,051.59 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |
Unspecified maxillofacial prosthesis, by report, provided by a nonphysician
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,051.59 | $1,051.59 | $1,051.59 | |
Cigna
| Professional | $893.86 | $893.86 | $1,051.59 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |