| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $350.00 | $350.00 | $350.00 | |
Capital Blue Cross
| Facility | $967.00 | $967.00 | $967.00 | |
Martin's Point
| Professional | $350.00 | $350.00 | $350.00 |
SurGraft, per sq cm (add-on, list separately in addition to primary procedure)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $350.00 | $350.00 | $350.00 | |
Capital Blue Cross
| Facility | $967.00 | $967.00 | $967.00 | |
Martin's Point
| Professional | $350.00 | $350.00 | $350.00 |