| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $117.89 | $3,294.00 | $7,568.00 | |
United
| Facility | $1,078.00 | $1,556.00 | $4,495.00 |
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 | $117.89 | $3,294.00 | $7,568.00 | |
United
| Facility | $1,078.00 | $1,556.00 | $4,495.00 |