| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $29.51 | $51.29 | $4,365.16 | |
United
| Facility | $467.74 | $1,148.15 | $1,548.82 |
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 |
|---|---|---|---|---|---|
Medica
| Facility | $29.51 | $51.29 | $4,365.16 | |
United
| Facility | $467.74 | $1,148.15 | $1,548.82 |