Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, 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 | $794.00 | $3,379.00 | $11,550.00 | |
Aetna
| Professional | $412.00 | $1,203.00 | $11,550.00 | |
Cigna
| Facility | $323.00 | $323.00 | $323.00 | |
United
| Facility | $331.00 | $1,986.00 | $4,970.00 | |
Wellpoint
| Professional | $16.00 | $16.00 | $16.00 |