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Nebraska rates for HCPCS A4100

Nonsheet form skin substitute, FDA-cleared as a device, not otherwise specified (list in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $102.33 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $93.33 / $125.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $3,162.28 / $6,165.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $147.91 / $181.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $3.02 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $239.88 / $263.03