| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $149.40 | $149.40 | $153.00 | |
Cigna
| Professional | $153.00 | $153.00 | $153.00 | |
United
| Professional | $162.00 | $173.53 | $270.00 |
Vim, 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 | $149.40 | $149.40 | $153.00 | |
Cigna
| Professional | $153.00 | $153.00 | $153.00 | |
United
| Professional | $162.00 | $173.53 | $270.00 |