| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $108.33 | $2,145.78 | $7,838.38 | |
Providence
| Facility | $83.96 | $149.21 | $178.86 | |
United
| Facility | $230.00 | $1,158.00 | $1,401.00 |
Epidermal 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 | $108.33 | $2,145.78 | $7,838.38 | |
Providence
| Facility | $83.96 | $149.21 | $178.86 | |
United
| Facility | $230.00 | $1,158.00 | $1,401.00 |