| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $119.36 | $119.36 | $119.36 | |
Providence
| Facility | $66.97 | $126.60 | $243.75 |
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 |
|---|---|---|---|---|---|
Cigna
| Facility | $119.36 | $119.36 | $119.36 | |
Providence
| Facility | $66.97 | $126.60 | $243.75 |