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Nebraska rates for HCPCS 15100

Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,318.31 / $4,778.89 / $12,765.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$649.20 / $801.49 / $3,485.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,335.87 / $4,387.57 / $8,486.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$686.33 / $1,169.88 / $1,586.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$719.58 / $1,892.62 / $2,448.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.30 / $1,462.98 / $3,339.76
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,013.70 / $1,786.03 / $6,396.72
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,471.64 / $1,765.96 / $2,341.94
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,282.02 / $1,687.21 / $2,339.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,510.02 / $2,707.88 / $7,772.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,013.70 / $1,740.58 / $2,009.58