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 | $2,056.00 | $2,878.00 | $4,933.00 | |
BCBS
| Facility | $0.02 | $0.06 | $0.10 | |
Health Alliance Plan
| Facility | $2,056.00 | $2,878.00 | $4,933.00 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 | |
United
| Facility | $700.00 | $1,209.00 | $2,029.00 |