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Nebraska rates for HCPCS Q4103

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.38 / $12.38 / $12.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $13.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $14.14 / $14.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.32 / $14.02 / $14.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.19 / $12.49 / $13.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $15.04 / $19.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.38 / $19.55 / $29.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.38 / $12.38 / $16.19
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.23 / $15.04 / $18.72
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.88 / $15.04 / $20.35
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.90 / $12.90 / $15.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.87 / $12.49 / $16.19