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Nebraska rates for HCPCS 15121

Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, 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
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,083.97 / $8,477.27 / $19,276.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,335.87 / $4,387.57 / $8,486.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.01 / $334.51 / $1,242.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.02 / $447.59 / $661.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,031.00 / $1,775.00 / $4,406.00