| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,464.00 | $6,782.00 | $13,413.92 | |
Moda Health
| Facility | $171.69 | $878.66 | $1,230.11 | |
Providence
| Facility | $171.69 | $878.66 | $1,230.11 |
Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) (List separately in addition to code for primary procedure)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,464.00 | $6,782.00 | $13,413.92 | |
Moda Health
| Facility | $171.69 | $878.66 | $1,230.11 | |
Providence
| Facility | $171.69 | $878.66 | $1,230.11 |