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 | $903.00 | $4,311.00 | $7,968.00 | |
Aetna
| Professional | $500.00 | $725.00 | $5,449.00 | |
United
| Facility | $361.00 | $896.00 | $2,229.00 | |
Wellcare
| Facility | $100.00 | $100.00 | $100.00 |