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Nebraska rates for HCPCS Q4138

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.11 / $98.11 / $100.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.11 / $98.11 / $107.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.41 / $111.07 / $111.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.52 / $111.06 / $113.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.11 / $98.11 / $98.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.11 / $113.11 / $145.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.40 / $170.68 / $226.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.26 / $100.40 / $282.39
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.67 / $113.11 / $243.27
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.67 / $120.48 / $145.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.20 / $98.11 / $147.16