go back

Nebraska rates for HCPCS 15131

Dermal autograft, trunk, arms, legs; 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
$1,506.15 / $5,463.36 / $13,841.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.83 / $88.25 / $477.13
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
$80.79 / $137.13 / $183.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.88 / $214.70 / $293.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.83 / $158.30 / $1,242.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.66 / $206.52 / $758.33
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.22 / $214.70 / $299.29
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.00 / $209.01 / $275.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,056.00 / $1,562.00 / $4,317.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.66 / $208.33 / $224.90