| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $190.55 | $4,570.88 | $8,511.38 | |
U of Utah Health Plan
| Professional | $134.90 | $239.88 | $380.19 | |
United
| Facility | $1,071.52 | $4,466.84 | $5,128.61 |
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 | $190.55 | $4,570.88 | $8,511.38 | |
U of Utah Health Plan
| Professional | $134.90 | $239.88 | $380.19 | |
United
| Facility | $1,071.52 | $4,466.84 | $5,128.61 |