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Nebraska rates for HCPCS 15274

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,545.00 / $5,909.48 / $20,928.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.03 / $75.16 / $417.08
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
$41.56 / $79.06 / $148.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.40 / $147.76 / $213.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.45 / $108.49 / $1,242.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.13 / $162.33 / $3,377.81
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.29 / $141.72 / $222.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.29 / $133.91 / $213.15
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
$92.13 / $142.58 / $190.15