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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
$3,083.01 / $7,119.04 / $19,276.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$470.75 / $860.06 / $1,982.82
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
$759.36 / $1,301.90 / $1,757.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$770.33 / $2,057.08 / $2,680.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.61 / $1,505.11 / $3,726.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,101.18 / $1,940.17 / $6,925.92
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,415.00 / $1,844.64 / $2,444.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,356.12 / $1,840.11 / $2,479.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,044.00 / $3,726.00 / $7,934.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,101.18 / $1,897.23 / $2,175.94