| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $3.00 | $3.00 | $3.00 | |
Medica
| Facility | $76.00 | $100.00 | $100.00 |
Nonsheet form skin substitute, FDA-cleared as a device, not otherwise specified (list in addition to primary procedure)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $3.00 | $3.00 | $3.00 | |
Medica
| Facility | $76.00 | $100.00 | $100.00 |