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Nebraska rates for HCPCS G0400

Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.62 / $99.62 / $99.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.62 / $150.00 / $165.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$320.51 / $414.74 / $650.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.23 / $81.29 / $81.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.02 / $275.13 / $492.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.62 / $169.35 / $426.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.43 / $358.99 / $858.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.53 / $247.53 / $508.75
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.02 / $284.92 / $422.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.43 / $358.99 / $489.23