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Nebraska rates for HCPCS 15276

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; 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
$1,506.15 / $5,463.36 / $13,841.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.84 / $29.96 / $164.82
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
$24.00 / $42.46 / $59.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.58 / $71.88 / $99.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.90 / $53.37 / $1,242.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.28 / $70.97 / $2,582.05
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.87 / $69.02 / $99.64
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.18 / $67.09 / $87.44
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
$40.28 / $70.87 / $77.66