| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $501.19 | $2,398.83 | $6,606.93 | |
Medica
| Facility | $134.90 | $199.53 | $1,862.09 | |
United
| Facility | $138.04 | $707.95 | $1,659.59 |
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 | $501.19 | $2,398.83 | $6,606.93 | |
Medica
| Facility | $134.90 | $199.53 | $1,862.09 | |
United
| Facility | $138.04 | $707.95 | $1,659.59 |