| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $344.00 | $344.00 | $344.00 | |
Medcost
| Facility | $447.20 | $447.20 | $447.20 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |
Supra sdrm, per sq cm
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $344.00 | $344.00 | $344.00 | |
Medcost
| Facility | $447.20 | $447.20 | $447.20 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |