| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $36.00 | $36.00 | $43.20 | |
Cigna
| Professional | $84.00 | $84.00 | $84.00 | |
MVP Health Care
| Professional | $84.00 | $84.00 | $84.00 |
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
| Professional | $36.00 | $36.00 | $43.20 | |
Cigna
| Professional | $84.00 | $84.00 | $84.00 | |
MVP Health Care
| Professional | $84.00 | $84.00 | $84.00 |