| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $193.74 | $6,541.00 | $13,413.92 | |
Moda Health
| Facility | $221.23 | $316.36 | $457.63 | |
Providence
| Facility | $221.23 | $316.36 | $457.63 |
Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; each additional 100 sq cm, or part thereof, or each additional 1% of body area of infants and children (List separately in addition to code for primary procedure)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $193.74 | $6,541.00 | $13,413.92 | |
Moda Health
| Facility | $221.23 | $316.36 | $457.63 | |
Providence
| Facility | $221.23 | $316.36 | $457.63 |