| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $350.00 | $350.00 | $350.00 | |
Health Alliance Plan
| Professional | $350.00 | $350.00 | $350.00 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 |
SurGraft, per sq cm (add-on, list separately in addition to primary procedure)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $350.00 | $350.00 | $350.00 | |
Health Alliance Plan
| Professional | $350.00 | $350.00 | $350.00 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 |