| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $81.00 | $81.00 | $81.00 | |
Medica
| Facility | $81.00 | $136.88 | $221.94 | |
Midlands
| Professional | $38.40 | $38.40 | $38.40 |
XCM biologic tissue matrix, per sq cm (add-on, list separately in addition to primary procedure)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $81.00 | $81.00 | $81.00 | |
Medica
| Facility | $81.00 | $136.88 | $221.94 | |
Midlands
| Professional | $38.40 | $38.40 | $38.40 |