| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $69.18 | $77.62 | $77.62 | |
Aetna
| Professional | $69.18 | $93.33 | $123.03 | |
Cigna
| Facility | $64.57 | $64.57 | $64.57 | |
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
| Facility | $69.18 | $77.62 | $77.62 | |
Aetna
| Professional | $69.18 | $93.33 | $123.03 | |
Cigna
| Facility | $64.57 | $64.57 | $64.57 | |
United
| Professional | $125.89 | $125.89 | $125.89 |