| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $76.92 | $146.93 | $8,500.00 | |
Medica
| Facility | $76.92 | $146.93 | $249.78 |
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 | $76.92 | $146.93 | $8,500.00 | |
Medica
| Facility | $76.92 | $146.93 | $249.78 |