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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)

Facilitymedian $4 · 10th–90th $2–$2090%10%20%10th90th$4Professionalmedian $2 · 10th–90th $2–$150%50%90th$2$2.0$10.0$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.00 / $2.51 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $3.02
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.09 / $2.69 / $2.82
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.63 / $2.63 / $2.82
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $208.93 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.95 / $11.48 / $125.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.45 / $3.98 / $14.79
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.45 / $2.45 / $16.22
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.82 / $10.96 / $15.49
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $208.93 / $309.03
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.17 / $6.17 / $15.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9.12 / $15.14 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.12 / $120.23 / $125.89