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 greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, 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 | $1,184.00 | $3,232.00 | $8,000.00 | |
Aetna
| Professional | $637.00 | $1,705.00 | $5,389.00 | |
Medica
| Facility | $100.00 | $815.00 | $1,351.00 | |
United
| Facility | $245.00 | $875.00 | $1,351.00 |