| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $125.25 | $784.00 | $1,831.00 | |
United
| Facility | $225.00 | $513.00 | $1,581.00 |
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 | $125.25 | $784.00 | $1,831.00 | |
United
| Facility | $225.00 | $513.00 | $1,581.00 |