| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $50.12 | $50.12 | $50.12 | |
Aetna
| Professional | $50.12 | $50.12 | $50.12 | |
Medica
| Facility | $50.12 | $52.48 | $134.90 | |
Medica
| Professional | $138.04 | $138.04 | $138.04 |
Compression burn garment, facial hood, custom fabricated
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $50.12 | $50.12 | $50.12 | |
Aetna
| Professional | $50.12 | $50.12 | $50.12 | |
Medica
| Facility | $50.12 | $52.48 | $134.90 | |
Medica
| Professional | $138.04 | $138.04 | $138.04 |