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Nebraska rates for HCPCS 15275

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$581.94 / $4,518.60 / $13,841.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.54 / $147.90 / $631.00
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
$91.29 / $173.16 / $296.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.96 / $288.85 / $457.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.76 / $258.83 / $3,047.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.29 / $329.98 / $3,593.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.59 / $258.63 / $425.15
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.09 / $288.85 / $425.15
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
$187.29 / $334.44 / $374.19