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Nebraska rates for HCPCS Q4180

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $660.69 / $660.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $794.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $707.95 / $741.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $707.95 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $223.87 / $309.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,047.13 / $1,318.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,318.26 / $2,089.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,096.48 / $1,621.81
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,230.27 / $1,584.89
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $208.93 / $309.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,584.89 / $2,754.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,698.24 / $2,754.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $1,023.29 / $1,659.59