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Nebraska rates for HCPCS C5274

Application Of Low Cost 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
$2,834.13 / $5,909.48 / $13,841.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$779.00 / $1,556.10 / $11,100.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,335.87 / $4,387.57 / $8,486.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,242.00 / $1,775.00 / $4,406.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,031.00 / $1,775.00 / $4,406.00