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Nebraska rates for HCPCS 15277

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, 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
$1,128.70 / $4,778.89 / $13,841.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.82 / $315.99 / $1,183.70
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
$210.97 / $396.22 / $627.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$418.21 / $675.41 / $958.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$276.10 / $552.98 / $3,047.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$401.11 / $706.71 / $2,508.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$514.49 / $714.30 / $1,864.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$445.96 / $624.78 / $928.37
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
$401.11 / $684.43 / $816.20