| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $68.13 | $68.13 | $68.13 | |
Aetna
| Professional | $68.13 | $68.13 | $91.87 | |
Cigna
| Professional | $35.29 | $35.29 | $35.29 | |
Medica
| Facility | $91.87 | $155.26 | $251.72 |
Orthotic and prosthetic supply, accessory, and/or service component of another HCPCS L code
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $68.13 | $68.13 | $68.13 | |
Aetna
| Professional | $68.13 | $68.13 | $91.87 | |
Cigna
| Professional | $35.29 | $35.29 | $35.29 | |
Medica
| Facility | $91.87 | $155.26 | $251.72 |