| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $120.23 | $120.23 | $120.23 | |
MountainHealth Co-op
| Facility | $128.82 | $162.18 | $251.19 | |
Providence
| Facility | $66.07 | $120.23 | $213.80 |
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 | $120.23 | $120.23 | $120.23 | |
MountainHealth Co-op
| Facility | $128.82 | $162.18 | $251.19 | |
Providence
| Facility | $66.07 | $120.23 | $213.80 |