| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $104.71 | $104.71 | $107.15 | |
Aetna
| Professional | $72.44 | $95.50 | $109.65 | |
Molina
| Professional | $21.38 | $42.66 | $67.61 | |
United
| Professional | $107.15 | $125.89 | $138.04 |
SUPRATHEL, 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 | $104.71 | $104.71 | $107.15 | |
Aetna
| Professional | $72.44 | $95.50 | $109.65 | |
Molina
| Professional | $21.38 | $42.66 | $67.61 | |
United
| Professional | $107.15 | $125.89 | $138.04 |