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Nebraska rates for HCPCS 15152

Tissue cultured skin 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
$302.00 / $3,801.89 / $12,589.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $4,365.16 / $8,511.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $245.47 / $1,230.27
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $331.13 / $426.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,548.82 / $4,570.88