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Nebraska rates for HCPCS Q4164

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,640.93 / $1,640.93 / $1,640.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,640.93 / $1,640.93 / $1,805.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,579.05 / $1,857.70 / $1,857.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,764.81 / $1,857.70 / $1,857.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,640.93 / $1,640.93 / $1,640.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.58 / $1,537.56 / $2,059.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,476.84 / $2,707.53 / $3,117.77
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.14 / $1,640.93 / $1,640.93
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$386.58 / $496.11 / $1,969.11
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.58 / $1,537.56 / $2,059.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,558.88 / $1,640.93 / $1,640.93