| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $162.18 | $3,162.28 | $4,570.88 | |
U of Utah Health Plan
| Professional | $165.96 | $208.93 | $269.15 | |
United
| Facility | $1,071.52 | $4,466.84 | $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 | $162.18 | $3,162.28 | $4,570.88 | |
U of Utah Health Plan
| Professional | $165.96 | $208.93 | $269.15 | |
United
| Facility | $1,071.52 | $4,466.84 | $5,128.61 |