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Nebraska rates for HCPCS Q4158

Kerecis Omega3, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.31 / $67.27 / $67.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $67.27 / $74.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.73 / $76.16 / $76.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.31 / $75.06 / $76.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.27 / $67.27 / $67.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $86.02 / $113.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.31 / $112.08 / $176.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.62 / $66.31 / $221.12
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.34 / $79.58 / $120.10
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.34 / $79.58 / $113.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.91 / $67.27 / $74.00