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Nebraska rates for HCPCS A2001

InnovaMatrix AC, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,200.00 / $1,200.00 / $1,200.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,200.00 / $1,200.00 / $1,275.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$971.27 / $1,012.17 / $1,022.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,275.00 / $1,275.00 / $1,275.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,227.42 / $2,120.96 / $2,524.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,200.00 / $1,860.00 / $2,280.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,250.00 / $1,250.00 / $1,500.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,227.42 / $1,652.10 / $2,327.55
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,227.42 / $1,652.10 / $2,327.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,187.50 / $1,250.00 / $1,875.00