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Nebraska rates for HCPCS Q4107

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.90 / $80.90 / $101.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.90 / $80.90 / $85.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.35 / $104.83 / $3,549.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.59 / $104.83 / $104.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.96 / $168.59 / $197.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.96 / $116.98 / $167.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.90 / $137.53 / $218.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.47 / $136.47 / $140.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.37 / $111.99 / $167.39
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.78 / $116.98 / $167.58
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.69 / $158.69 / $192.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.65 / $136.47 / $136.47