| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,139.00 | $3,158.00 | $8,000.00 | |
Aetna
| Professional | $36.00 | $36.00 | $36.00 | |
Medica
| Facility | $36.00 | $73.44 | $1,264.00 | |
United
| Facility | $245.00 | $875.00 | $1,351.00 |
Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,139.00 | $3,158.00 | $8,000.00 | |
Aetna
| Professional | $36.00 | $36.00 | $36.00 | |
Medica
| Facility | $36.00 | $73.44 | $1,264.00 | |
United
| Facility | $245.00 | $875.00 | $1,351.00 |