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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
$12.88 / $12.88 / $12.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $12.88 / $18.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.96 / $14.45 / $14.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.80 / $13.80 / $14.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.80 / $190.55 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.59 / $12.88 / $22.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.45 / $17.38 / $28.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $14.45 / $15.85
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.12 / $17.38 / $22.91
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.80 / $204.17 / $309.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $22.91 / $36.31
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.13 / $14.13 / $16.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.30 / $20.42 / $33.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $12.88 / $125.89