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Nebraska rates for HCPCS 15273

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,653.00 / $6,048.00 / $22,634.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.65 / $284.49 / $1,042.91
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
$184.90 / $348.35 / $568.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.56 / $606.94 / $871.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.50 / $497.86 / $6,098.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.50 / $643.98 / $3,837.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$453.60 / $655.59 / $3,718.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.89 / $565.90 / $837.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,341.00 / $7,441.00 / $8,816.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.50 / $643.98 / $734.84