| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Health Alliance Plan
| Facility | $669.89 | $669.89 | $669.89 | |
Health Alliance Plan
| Professional | $46.16 | $669.89 | $693.38 |
Ablative laser treatment, non-contact, full field and fractional ablation, open wound, per day, total treatment surface area; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Health Alliance Plan
| Facility | $669.89 | $669.89 | $669.89 | |
Health Alliance Plan
| Professional | $46.16 | $669.89 | $693.38 |