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Nebraska rates for HCPCS 15220

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,175.25 / $4,778.89 / $13,841.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.77 / $711.72 / $3,221.86
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
$594.03 / $1,025.09 / $1,427.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$637.59 / $1,689.95 / $2,214.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$711.72 / $1,271.18 / $3,726.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$910.11 / $1,603.53 / $5,728.24
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,261.70 / $1,629.75 / $2,068.10
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,145.00 / $1,515.00 / $2,059.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,679.00 / $3,167.00 / $7,772.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$910.11 / $1,562.91 / $1,800.65