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Nebraska rates for HCPCS Q4153

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.60 / $137.93 / $137.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $137.93 / $151.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.72 / $156.15 / $156.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.80 / $148.34 / $156.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.93 / $137.93 / $137.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.08 / $163.13 / $271.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.60 / $179.19 / $260.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.60 / $108.60 / $305.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.69 / $153.69 / $302.52
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.32 / $159.88 / $349.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.03 / $137.93 / $151.72