| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medcost
| Facility | $61.66 | $61.66 | $61.66 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 | |
United
| Facility | $436.52 | $436.52 | $446.68 |
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 |
|---|---|---|---|---|---|
Medcost
| Facility | $61.66 | $61.66 | $61.66 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 | |
United
| Facility | $436.52 | $436.52 | $446.68 |