| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $497.00 | $1,300.00 | $3,685.00 | |
Aetna
| Professional | $1,172.00 | $1,927.00 | $3,779.00 | |
BCBS
| Facility | $0.78 | $1.65 | $2.21 | |
United
| Facility | $194.00 | $513.00 | $1,226.00 |
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 | $497.00 | $1,300.00 | $3,685.00 | |
Aetna
| Professional | $1,172.00 | $1,927.00 | $3,779.00 | |
BCBS
| Facility | $0.78 | $1.65 | $2.21 | |
United
| Facility | $194.00 | $513.00 | $1,226.00 |