| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $110.43 | $188.38 | $8,500.00 | |
Medica
| Facility | $110.43 | $188.38 | $331.29 |
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 | $110.43 | $188.38 | $8,500.00 | |
Medica
| Facility | $110.43 | $188.38 | $331.29 |