| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $350.00 | $350.00 | $350.00 | |
Medcost
| Facility | $455.00 | $455.00 | $455.00 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |
Surgraft Per Square Centimeter
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $350.00 | $350.00 | $350.00 | |
Medcost
| Facility | $455.00 | $455.00 | $455.00 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |