| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Facility | $1,659.59 | $3,630.78 | $5,011.87 | |
Cigna
| Facility | $50,118.72 | $50,118.72 | $53,703.18 | |
United
| Facility | $338.84 | $758.58 | $2,454.71 |
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; 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 |
|---|---|---|---|---|---|
BCBS
| Facility | $1,659.59 | $3,630.78 | $5,011.87 | |
Cigna
| Facility | $50,118.72 | $50,118.72 | $53,703.18 | |
United
| Facility | $338.84 | $758.58 | $2,454.71 |
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