| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
United
| Facility | $5,000.00 | $5,000.00 | $5,000.00 |
Medical/Surgical Supplies and Devices-Prosthetic/Orthotic Devices
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
United
| Facility | $5,000.00 | $5,000.00 | $5,000.00 |