| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $72.00 | $72.00 | $72.00 | |
Aetna
| Professional | $72.00 | $87.57 | $400.00 | |
Medica
| Facility | $72.00 | $87.57 | $755.47 |
Work related or medical disability examination by other than the treating physician that includes: Completion of a medical history commensurate with the patient's condition; Performance of an examination commensurate with the patient's condition; Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; Development of future medical treatment plan; and Completion of necessary documentation/certificates and report.
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $72.00 | $72.00 | $72.00 | |
Aetna
| Professional | $72.00 | $87.57 | $400.00 | |
Medica
| Facility | $72.00 | $87.57 | $755.47 |