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Nebraska rates for HCPCS Q4191

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $655.29 / $730.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $720.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.59 / $741.87 / $741.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$704.77 / $741.87 / $826.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $1,170.09 / $1,745.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$730.43 / $1,241.73 / $3,442.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$730.43 / $730.43 / $1,749.83
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$876.52 / $1,128.18 / $1,447.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$876.52 / $1,128.18 / $1,826.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$622.54 / $655.29 / $720.83