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Nebraska rates for HCPCS Q4132

Grafix Core and GrafixPL Core, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.18 / $89.18 / $106.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $117.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.68 / $120.80 / $120.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.90 / $114.76 / $120.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.70 / $193.05 / $219.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $106.70 / $205.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.18 / $151.61 / $354.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.50 / $89.18 / $563.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.00 / $107.02 / $205.28
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $157.56 / $291.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.37 / $106.70 / $160.05