| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $131.71 | $193.06 | $8,500.00 | |
Medica
| Facility | $131.71 | $193.06 | $395.13 |
Drs&/Dbrdmt Prtl-Thkns Burns 1st/Sbsq Large
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $131.71 | $193.06 | $8,500.00 | |
Medica
| Facility | $131.71 | $193.06 | $395.13 |