| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $87.98 | $87.98 | $87.98 | |
Cigna
| Facility | $87.98 | $87.98 | $87.98 | |
Cigna
| Professional | $87.98 | $87.98 | $87.98 | |
United
| Professional | $74.78 | $87.98 | $142.60 |
AMNIOREPAIR or AltiPly, 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 | $87.98 | $87.98 | $87.98 | |
Cigna
| Facility | $87.98 | $87.98 | $87.98 | |
Cigna
| Professional | $87.98 | $87.98 | $87.98 | |
United
| Professional | $74.78 | $87.98 | $142.60 |