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 Surfacearea 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 | $100.00 | $1,749.77 | $9,859.00 | |
Anthem BCBS
| Professional | $8.01 | $8.01 | $8.01 | |
United
| Facility | $7,448.00 | $7,448.00 | $7,448.00 | |
Well Sense
| Professional | $2,500.00 | $2,750.00 | $3,500.00 |