| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,897.00 | $4,500.00 | $7,761.00 | |
Moda Health
| Facility | $126.42 | $191.35 | $313.13 | |
United
| Facility | $1,800.00 | $8,244.00 | $9,193.00 |
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 | $2,897.00 | $4,500.00 | $7,761.00 | |
Moda Health
| Facility | $126.42 | $191.35 | $313.13 | |
United
| Facility | $1,800.00 | $8,244.00 | $9,193.00 |