| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $85.00 | $100.00 | $100.00 | |
Medica
| Professional | $189.58 | $199.56 | $220.05 | |
United
| Professional | $191.78 | $199.56 | $220.05 |
Amnio Wound, per sq cm (add-on, list separately in addition to primary procedure)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $85.00 | $100.00 | $100.00 | |
Medica
| Professional | $189.58 | $199.56 | $220.05 | |
United
| Professional | $191.78 | $199.56 | $220.05 |