| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $100.19 | $109.98 | $1,400.00 | |
CareSource
| Facility | $108.30 | $123.72 | $134.80 | |
Cigna
| Facility | $173.66 | $173.66 | $173.66 |
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 | $100.19 | $109.98 | $1,400.00 | |
CareSource
| Facility | $108.30 | $123.72 | $134.80 | |
Cigna
| Facility | $173.66 | $173.66 | $173.66 |