| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,017.00 | $3,575.00 | $4,601.00 | |
Aetna
| Professional | $29.50 | $29.50 | $29.94 | |
Cigna
| Professional | $13.20 | $13.20 | $13.20 | |
United
| Facility | $165.00 | $442.00 | $5,940.00 |
Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,017.00 | $3,575.00 | $4,601.00 | |
Aetna
| Professional | $29.50 | $29.50 | $29.94 | |
Cigna
| Professional | $13.20 | $13.20 | $13.20 | |
United
| Facility | $165.00 | $442.00 | $5,940.00 |