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Nebraska rates for HCPCS Q4123

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $78.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.84 / $81.00 / $81.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.95 / $81.00 / $81.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.87 / $23.87 / $71.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.24 / $71.55 / $110.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.30 / $84.22 / $132.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $79.78
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.43 / $85.86 / $85.86
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.80 / $51.71 / $85.86
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.50 / $22.50 / $27.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.97 / $71.55 / $78.70