| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $435.66 | $6,541.00 | $13,413.92 | |
Moda Health
| Facility | $695.08 | $973.11 | $1,029.08 | |
Providence
| Facility | $695.08 | $973.11 | $1,029.08 |
Tissue cultured skin 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 | $435.66 | $6,541.00 | $13,413.92 | |
Moda Health
| Facility | $695.08 | $973.11 | $1,029.08 | |
Providence
| Facility | $695.08 | $973.11 | $1,029.08 |