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Nebraska rates for HCPCS 15201

Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, 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 / $5,011.87 / $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
$69.18 / $181.97 / $1,230.27
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $257.04 / $416.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,548.82 / $4,570.88