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Nebraska rates for HCPCS 15272

Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.48 / $4,073.80 / $32,359.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $30.90 / $87.10
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
$19.05 / $30.20 / $46.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.42 / $47.86 / $70.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $39.81 / $1,230.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $54.95 / $3,801.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $53.70 / $75.86
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $52.48 / $53.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,548.82 / $4,570.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $37.15 / $57.54