| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $128.82 | $141.25 | $8,511.38 | |
Medica
| Facility | $141.25 | $186.21 | $426.58 | |
United
| Facility | $4,677.35 | $5,128.61 | $5,128.61 |
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 | $128.82 | $141.25 | $8,511.38 | |
Medica
| Facility | $141.25 | $186.21 | $426.58 | |
United
| Facility | $4,677.35 | $5,128.61 | $5,128.61 |