| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $89.75 | $89.75 | $89.75 | |
Cigna
| Facility | $89.75 | $89.75 | $89.75 | |
Cigna
| Professional | $89.75 | $89.75 | $89.75 | |
United
| Professional | $89.75 | $89.75 | $1,417.41 |
Enverse, 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 | $89.75 | $89.75 | $89.75 | |
Cigna
| Facility | $89.75 | $89.75 | $89.75 | |
Cigna
| Professional | $89.75 | $89.75 | $89.75 | |
United
| Professional | $89.75 | $89.75 | $1,417.41 |