| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $576.78 | $10,175.36 | $13,413.92 | |
Moda Health
| Facility | $644.80 | $922.08 | $1,362.45 | |
Providence
| Facility | $644.80 | $922.08 | $1,362.45 |
Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; 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 | $576.78 | $10,175.36 | $13,413.92 | |
Moda Health
| Facility | $644.80 | $922.08 | $1,362.45 | |
Providence
| Facility | $644.80 | $922.08 | $1,362.45 |