| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $135.37 | $142.57 | $1,400.00 | |
CareSource
| Facility | $153.05 | $173.24 | $188.74 | |
Cigna
| Facility | $245.42 | $245.42 | $245.42 |
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 |
|---|---|---|---|---|---|
Aetna
| Facility | $135.37 | $142.57 | $1,400.00 | |
CareSource
| Facility | $153.05 | $173.24 | $188.74 | |
Cigna
| Facility | $245.42 | $245.42 | $245.42 |