| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,047.13 | $1,047.13 | $1,047.13 | |
Cigna
| Professional | $891.25 | $891.25 | $1,047.13 | |
Molina
| Professional | $30.20 | $44.67 | $60.26 |
Unspecified maxillofacial prosthesis, by report, provided by a nonphysician
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,047.13 | $1,047.13 | $1,047.13 | |
Cigna
| Professional | $891.25 | $891.25 | $1,047.13 | |
Molina
| Professional | $30.20 | $44.67 | $60.26 |