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Nebraska rates for HCPCS Q4116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.89 / $8,351.07 / $54,325.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.89 / $24.89 / $26.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.70 / $35.22 / $3,549.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.46 / $35.21 / $35.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.11 / $38.00 / $67.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $39.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.89 / $42.31 / $74.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.72 / $40.18 / $46.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.72 / $39.03 / $49.69
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.80 / $51.80 / $62.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.55 / $31.11 / $31.11