| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $95.50 | $95.50 | $407.38 | |
Harvard Pilgrim
| Facility | $5,011.87 | $5,011.87 | $5,011.87 | |
United
| Facility | $5,011.87 | $5,011.87 | $5,011.87 |
Medical/Surgical Supplies and Devices-Prosthetic/Orthotic Devices
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $95.50 | $95.50 | $407.38 | |
Harvard Pilgrim
| Facility | $5,011.87 | $5,011.87 | $5,011.87 | |
United
| Facility | $5,011.87 | $5,011.87 | $5,011.87 |