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Nebraska rates for HCPCS Q4125

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.91 / $138.91 / $138.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.74 / $138.91 / $138.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.89 / $193.89 / $193.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.91 / $222.27 / $263.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.74 / $50.74 / $50.74
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.74 / $50.74 / $50.74
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.74 / $50.74 / $50.74