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Nebraska rates for HCPCS A2013

Innovamatrix Fs, Per Sq Cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,296.00 / $1,296.00 / $1,296.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,296.00 / $1,296.00 / $1,377.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,452.73 / $3,549.39 / $6,139.22
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,083.38 / $1,129.00 / $1,140.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,377.00 / $1,377.00 / $1,377.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,315.79 / $2,365.76 / $2,816.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,296.00 / $2,073.60 / $2,462.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,350.00 / $1,350.00 / $1,620.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,315.79 / $1,842.78 / $2,495.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,315.79 / $1,842.78 / $2,495.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,282.50 / $1,350.00 / $1,485.00