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Nebraska rates for HCPCS 15200

Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,083.97 / $8,477.27 / $19,276.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$611.86 / $769.03 / $3,530.87
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
$649.25 / $1,109.18 / $1,544.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$683.22 / $1,843.52 / $2,385.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$740.99 / $1,345.80 / $3,149.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$984.48 / $1,734.55 / $6,214.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,316.00 / $1,716.91 / $2,255.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,192.00 / $1,633.94 / $2,248.54
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
$984.48 / $1,757.99 / $1,945.65