| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.65 | $1,348.96 | $14,125.38 | |
Moda Health
| Facility | $95.50 | $165.96 | $1,230.27 | |
Providence
| Facility | $95.50 | $194.98 | $870.96 |
Split-thickness autograft, trunk, arms, legs; each additional 100 sq cm, 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 |
|---|---|---|---|---|---|
Aetna
| Facility | $0.65 | $1,348.96 | $14,125.38 | |
Moda Health
| Facility | $95.50 | $165.96 | $1,230.27 | |
Providence
| Facility | $95.50 | $194.98 | $870.96 |