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Nebraska rates for HCPCS 15120

Split-thickness 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 (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $4,365.16 / $12,022.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $933.25 / $2,570.40
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $4,365.16 / $8,511.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,148.15 / $1,584.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,862.09 / $2,454.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $1,348.96 / $5,370.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,737.80 / $6,309.57
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,949.84 / $2,454.71
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,862.09 / $2,089.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,365.16 / $5,495.41 / $8,912.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,445.44 / $1,949.84