go back

Nebraska rates for HCPCS 15115

Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,653.00 / $5,463.36 / $13,841.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$631.86 / $738.60 / $3,588.44
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
$655.95 / $1,128.21 / $1,518.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,337.48 / $1,780.28 / $2,293.57
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$635.77 / $1,426.70 / $4,882.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$947.37 / $1,778.66 / $6,003.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,421.20 / $1,716.91 / $2,154.58
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,279.00 / $1,724.13 / $2,154.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,679.00 / $3,167.00 / $7,772.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$947.37 / $1,691.73 / $1,868.66