| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,473.04 | $6,782.00 | $13,413.92 | |
Aetna
| Professional | $4,473.04 | $5,084.91 | $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 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 |
|---|---|---|---|---|---|
Aetna
| Facility | $4,473.04 | $6,782.00 | $13,413.92 | |
Aetna
| Professional | $4,473.04 | $5,084.91 | $14,552.94 | |
Providence
| Professional | $2,250,000.00 | $2,250,000.00 | $2,400,000.00 |