| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5,328.00 | $8,303.41 | $13,413.92 | |
Aetna
| Professional | $6,825.52 | $8,303.41 | $14,552.94 | |
Providence
| Professional | $2,250,000.00 | $2,250,000.00 | $2,400,000.00 |
Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5,328.00 | $8,303.41 | $13,413.92 | |
Aetna
| Professional | $6,825.52 | $8,303.41 | $14,552.94 | |
Providence
| Professional | $2,250,000.00 | $2,250,000.00 | $2,400,000.00 |