go back

Nebraska rates for HCPCS 15278

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; 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
$204.17 / $3,801.89 / $12,589.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $95.50 / $288.40
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $52.48 / $52.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $4,365.16 / $8,511.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $100.00 / $173.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $173.78 / $269.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $131.83 / $1,230.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $186.21 / $6,025.60
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $173.78 / $251.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $169.82 / $204.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,548.82 / $4,570.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $123.03 / $218.78