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Nebraska rates for HCPCS 15136

Dermal 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
$1,506.15 / $5,463.36 / $13,841.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.83 / $87.02 / $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
$80.45 / $135.78 / $182.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.88 / $213.47 / $290.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.83 / $153.58 / $1,242.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.43 / $203.37 / $758.33
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$174.75 / $211.79 / $296.16
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.96 / $209.01 / $275.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,031.00 / $1,775.00 / $4,406.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.43 / $196.05 / $222.52