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 | $1,894.00 | $1,894.00 | $17,823.00 | |
Anthem BCBS
| Facility | $1,139.00 | $1,183.00 | $1,530.00 | |
Medica
| Facility | $1,100.00 | $1,449.00 | $2,090.40 | |
Molina
| Professional | $55.00 | $65.00 | $70.00 | |
United
| Facility | $1,034.00 | $1,423.00 | $2,202.90 |