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Nebraska rates for HCPCS 15130

Dermal autograft, trunk, arms, legs; 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
$544.91 / $663.40 / $3,141.73
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
$576.01 / $980.29 / $1,325.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,141.91 / $1,572.88 / $2,049.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$571.09 / $1,228.72 / $4,217.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$845.96 / $1,490.51 / $5,312.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,177.22 / $1,560.85 / $1,962.18
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,066.00 / $1,353.58 / $1,896.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,217.00 / $6,451.00 / $7,934.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$845.96 / $1,510.65 / $1,713.56