| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Facility | $64,999.99 | $77,999.99 | $94,999.99 | |
Cigna
| Facility | $173.51 | $173.51 | $173.51 | |
Providence
| Facility | $99.01 | $173.51 | $311.35 |
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 |
|---|---|---|---|---|---|
BCBS
| Facility | $64,999.99 | $77,999.99 | $94,999.99 | |
Cigna
| Facility | $173.51 | $173.51 | $173.51 | |
Providence
| Facility | $99.01 | $173.51 | $311.35 |