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Nebraska rates for HCPCS Q4194

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$663.63 / $663.63 / $717.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $729.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$638.60 / $751.29 / $751.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.73 / $751.28 / $812.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$663.63 / $663.63 / $663.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $979.17 / $1,288.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$717.78 / $1,112.56 / $1,363.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$717.78 / $717.78 / $999.90
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$861.33 / $863.24 / $1,288.38
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.33 / $863.24 / $1,288.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.45 / $663.63 / $809.63