| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $139.03 | $5,975.00 | $10,692.00 | |
United
| Facility | $1,529.00 | $3,352.00 | $10,536.00 |
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 | $139.03 | $5,975.00 | $10,692.00 | |
United
| Facility | $1,529.00 | $3,352.00 | $10,536.00 |