Application Of Low Cost Skin Substitute Graft To Trunk Arms Legs Total Wound Surface Area Greater Than Or Equal To 100 Sq Cm; Each Additional 100 Sq Cm Wound Surface Area Or Part Thereof Or Each Additional 1% Of Body Area Of Infants And Children 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 | $2,834.13 | $5,909.48 | $13,841.56 | |
Aetna
| Professional | $779.00 | $1,556.10 | $11,100.08 | |
BCBS
| Facility | $3,335.87 | $4,387.57 | $8,486.99 | |
Medica
| Facility | $1,242.00 | $1,775.00 | $4,406.00 | |
United
| Facility | $1,031.00 | $1,775.00 | $4,406.00 |