| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $72.44 | $91.20 | $263.03 | |
BCBS
| Facility | $234.42 | $281.84 | $371.54 | |
United
| Professional | $125.89 | $125.89 | $125.89 |
Supra SDRM, per sq cm (add-on, list separately in addition to primary procedure)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $72.44 | $91.20 | $263.03 | |
BCBS
| Facility | $234.42 | $281.84 | $371.54 | |
United
| Professional | $125.89 | $125.89 | $125.89 |