| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $125.89 | $204.17 | $8,511.38 | |
Medica
| Facility | $134.90 | $208.93 | $398.11 | |
United
| Facility | $4,677.35 | $5,128.61 | $5,128.61 |
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 | $125.89 | $204.17 | $8,511.38 | |
Medica
| Facility | $134.90 | $208.93 | $398.11 | |
United
| Facility | $4,677.35 | $5,128.61 | $5,128.61 |