go back

Nebraska rates for HCPCS Q4183

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.00 / $80.00 / $85.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,452.73 / $3,549.39 / $6,139.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $120.00 / $152.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.91 / $160.91 / $165.75
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.09 / $108.09 / $108.09
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.09 / $108.09 / $108.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.87 / $160.91 / $160.91