| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,518.41 | $1,543.03 | $3,955.04 | |
United
| Facility | $540.00 | $1,401.00 | $4,915.00 |
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 | $1,518.41 | $1,543.03 | $3,955.04 | |
United
| Facility | $540.00 | $1,401.00 | $4,915.00 |