| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $1,339.00 | $1,339.00 | $1,339.00 | |
Medica
| Facility | $76.00 | $100.00 | $100.00 |
Supra sdrm, per sq cm
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $1,339.00 | $1,339.00 | $1,339.00 | |
Medica
| Facility | $76.00 | $100.00 | $100.00 |