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Nebraska rates for HCPCS Q4101

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $30.30 / $40.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $33.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.09 / $34.22 / $34.22
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.50 / $34.21 / $34.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $67.09 / $70.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $36.44 / $46.76
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.30 / $51.51 / $73.90
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.30 / $30.30 / $54.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.74 / $36.44 / $46.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.36 / $37.08 / $64.89
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.20 / $68.50 / $76.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.72 / $30.23 / $45.35