| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1.26 | $1.26 | $1.26 | |
Aetna
| Professional | $1.26 | $1.26 | $1.26 | |
Cigna
| Professional | $191.26 | $191.26 | $191.26 | |
Molina
| Professional | $30.00 | $45.00 | $60.00 |
Compression burn garment, upper trunk to waist including arm openings (vest), custom fabricated
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1.26 | $1.26 | $1.26 | |
Aetna
| Professional | $1.26 | $1.26 | $1.26 | |
Cigna
| Professional | $191.26 | $191.26 | $191.26 | |
Molina
| Professional | $30.00 | $45.00 | $60.00 |