| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $229.09 | $7,079.46 | $14,125.38 | |
Moda Health
| Facility | $64.57 | $125.89 | $660.69 | |
Providence
| Facility | $63.10 | $144.54 | $660.69 |
Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, 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 | $229.09 | $7,079.46 | $14,125.38 | |
Moda Health
| Facility | $64.57 | $125.89 | $660.69 | |
Providence
| Facility | $63.10 | $144.54 | $660.69 |