| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $154.88 | $1,584.89 | $2,818.38 | |
United
| Facility | $338.84 | $575.44 | $1,513.56 |
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 | $154.88 | $1,584.89 | $2,818.38 | |
United
| Facility | $338.84 | $575.44 | $1,513.56 |