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Nebraska rates for HCPCS Q4124

OASIS ultra tri-layer wound matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.48 / $2.48 / $2.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.73
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.39 / $2.81 / $2.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.66 / $2.81 / $2.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $2.49 / $18.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $10.91 / $14.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.48 / $4.34 / $20.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.48 / $2.48 / $16.19
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.91 / $10.91 / $14.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.98 / $10.91 / $15.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.37 / $2.49 / $2.74