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Nebraska rates for HCPCS 92004

Oph Svcs Medical Xm&Eval Compre New Pt 1/> Vst

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.19 / $90.19 / $141.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.74 / $141.86 / $317.00
Aetna
Facility/Professional
Professional
Modifier
25
Low / Median / High Price
$141.86 / $322.20 / $339.23
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.00 / $167.62 / $279.86
Ambetter
Facility/Professional
Professional
Modifier
25
Low / Median / High Price
$279.86 / $329.43 / $329.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.29 / $173.06 / $285.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.81 / $190.99 / $341.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.19 / $157.83 / $299.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.38 / $292.88 / $379.12
Medica
Facility/Professional
Professional
Modifier
25
Low / Median / High Price
$150.00 / $290.01 / $355.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.76 / $283.99 / $368.95
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.36 / $252.26 / $368.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.96 / $201.04 / $339.18