| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Facility | $275.42 | $891.25 | $1,348.96 | |
BCBS
| Professional | $46.77 | $66.07 | $107.15 | |
Medica
| Facility | $707.95 | $1,412.54 | $2,238.72 | |
United
| Facility | $316.23 | $707.95 | $1,584.89 |
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 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 |
|---|---|---|---|---|---|
BCBS
| Facility | $275.42 | $891.25 | $1,348.96 | |
BCBS
| Professional | $46.77 | $66.07 | $107.15 | |
Medica
| Facility | $707.95 | $1,412.54 | $2,238.72 | |
United
| Facility | $316.23 | $707.95 | $1,584.89 |