| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,407.00 | $4,500.00 | $7,045.00 | |
Moda Health
| Facility | $121.28 | $197.52 | $254.24 | |
United
| Facility | $1,800.00 | $8,244.00 | $9,193.00 |
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 | $1,407.00 | $4,500.00 | $7,045.00 | |
Moda Health
| Facility | $121.28 | $197.52 | $254.24 | |
United
| Facility | $1,800.00 | $8,244.00 | $9,193.00 |