| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $101.20 | $101.20 | $101.20 | |
Aetna
| Professional | $5.66 | $11.15 | $101.20 | |
Molina
| Professional | $30.00 | $45.00 | $60.00 |
Strattice Tm Per Square Centimeter
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $101.20 | $101.20 | $101.20 | |
Aetna
| Professional | $5.66 | $11.15 | $101.20 | |
Molina
| Professional | $30.00 | $45.00 | $60.00 |