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Nebraska rates for HCPCS 15240

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $6,165.95 / $11,481.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $1,071.52 / $2,238.72
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $616.60 / $1,737.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $4,365.16 / $8,511.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,318.26 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $2,041.74 / $2,754.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $1,479.11 / $3,715.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,905.46 / $6,918.31
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,137.96 / $2,691.53
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,041.74 / $2,398.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $3,162.28 / $8,128.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,621.81 / $2,187.76