| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $217.16 | $217.16 | $217.16 | |
Providence
| Facility | $122.54 | $163.98 | $318.52 |
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 | $217.16 | $217.16 | $217.16 | |
Providence
| Facility | $122.54 | $163.98 | $318.52 |