| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $218.78 | $218.78 | $218.78 | |
MountainHealth Co-op
| Facility | $234.42 | $257.04 | $281.84 | |
Providence
| Facility | $120.23 | $158.49 | $275.42 |
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 |
|---|---|---|---|---|---|
Cigna
| Facility | $218.78 | $218.78 | $218.78 | |
MountainHealth Co-op
| Facility | $234.42 | $257.04 | $281.84 | |
Providence
| Facility | $120.23 | $158.49 | $275.42 |