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Nebraska rates for HCPCS Q4115

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.86 / $14.48 / $14.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $14.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.38 / $14.56 / $14.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.83 / $14.56 / $16.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.86 / $13.82 / $13.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $17.27 / $22.73
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.48 / $21.72 / $27.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.38 / $14.48 / $14.48
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.76 / $14.86 / $19.70
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $14.86 / $19.70
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.00 / $13.00 / $15.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.22 / $12.86 / $12.86