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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
$54.95 / $8,317.64 / $54,954.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $25.12 / $30.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $35.48 / $4,265.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $33.11 / $35.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $190.55 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $30.90 / $39.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.12 / $37.15 / $74.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $30.90 / $30.90
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $38.02 / $38.02
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $204.17 / $309.03
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $56.23 / $64.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $30.90 / $125.89