| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $344.00 | $344.00 | $344.00 | |
Medica
| Facility | $344.00 | $581.36 | $942.56 |
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 | $344.00 | $344.00 | $344.00 | |
Medica
| Facility | $344.00 | $581.36 | $942.56 |