| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $344.00 | $344.00 | $344.00 | |
Aetna
| Professional | $344.00 | $344.00 | $344.00 | |
Molina
| Professional | $30.00 | $2,000.00 | $3,500.00 |
Supra sdrm, per sq cm
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $344.00 | $344.00 | $344.00 | |
Aetna
| Professional | $344.00 | $344.00 | $344.00 | |
Molina
| Professional | $30.00 | $2,000.00 | $3,500.00 |