| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Facility | $537.03 | $537.03 | $537.03 | |
Pacific Source
| Facility | $446.68 | $954.99 | $1,513.56 | |
Premera BCBS
| Facility | $234.42 | $234.42 | $354.81 |
Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Facility | $537.03 | $537.03 | $537.03 | |
Pacific Source
| Facility | $446.68 | $954.99 | $1,513.56 | |
Premera BCBS
| Facility | $234.42 | $234.42 | $354.81 |