| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $73.66 | $5,640.00 | $5,640.00 | |
CareSource
| Facility | $80.58 | $90.79 | $98.91 | |
Cigna
| Facility | $129.19 | $129.19 | $129.19 |
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 | $73.66 | $5,640.00 | $5,640.00 | |
CareSource
| Facility | $80.58 | $90.79 | $98.91 | |
Cigna
| Facility | $129.19 | $129.19 | $129.19 |