| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $358.00 | $358.00 | $358.00 | |
Medica
| Facility | $100.00 | $605.02 | $980.92 | |
Midlands
| Professional | $38.40 | $38.40 | $38.40 |
TENSIX, 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 | $358.00 | $358.00 | $358.00 | |
Medica
| Facility | $100.00 | $605.02 | $980.92 | |
Midlands
| Professional | $38.40 | $38.40 | $38.40 |