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 | $1,000.00 | $2,145.78 | $7,838.38 | |
BCBS
| Facility | $56,799.99 | $68,899.99 | $81,099.99 | |
Molina
| Professional | $60.00 | $60.00 | $85.00 | |
United
| Facility | $230.00 | $1,158.00 | $1,401.00 |