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Nebraska rates for HCPCS Q4141

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.75 / $64.75 / $106.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.97 / $106.97 / $117.66
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.93 / $121.10 / $121.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.62 / $115.04 / $121.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.97 / $106.97 / $106.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.30 / $51.29 / $106.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.28 / $88.37 / $123.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.86 / $64.75 / $116.76
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.30 / $45.44 / $77.70
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.30 / $54.25 / $77.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.62 / $106.97 / $116.76