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Nebraska rates for HCPCS A2015

Phoenix wound matrix, per square centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.83 / $88.83 / $88.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.83 / $88.83 / $540.42
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
$814.66 / $848.97 / $857.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.77 / $785.24 / $2,117.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.83 / $151.01 / $1,375.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,438.66 / $1,438.66 / $2,157.98
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.77 / $1,385.73 / $1,778.99
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.77 / $1,385.73 / $1,778.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,366.73 / $1,438.66 / $1,438.66