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Nebraska rates for HCPCS Q4156

Neox 100 or Clarix 100, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $66.07 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $66.07 / $79.43
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $70.79 / $74.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $70.79 / $74.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $208.93 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $66.07 / $95.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $100.00 / $177.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $66.07 / $181.97
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $77.62 / $100.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $208.93 / $309.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $100.00 / $165.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $107.15 / $169.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $125.89 / $154.88