| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $29.50 | $29.50 | $8,500.00 | |
Aetna
| Professional | $29.50 | $29.50 | $29.50 | |
Medica
| Facility | $29.50 | $29.50 | $88.50 |
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 | $29.50 | $29.50 | $8,500.00 | |
Aetna
| Professional | $29.50 | $29.50 | $29.50 | |
Medica
| Facility | $29.50 | $29.50 | $88.50 |