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Nebraska rates for HCPCS 15221

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 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
$685.40 / $4,778.89 / $13,841.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.26 / $119.81 / $404.00
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
$65.56 / $124.72 / $238.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.10 / $237.35 / $387.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.26 / $165.83 / $1,242.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.01 / $277.29 / $1,510.76
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.91 / $259.36 / $408.80
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.91 / $227.34 / $352.30
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
$159.01 / $283.95 / $309.47