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Nebraska rates for HCPCS Q4196

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.54 / $101.03 / $101.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.03 / $101.03 / $111.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.22 / $114.38 / $114.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.98 / $111.56 / $114.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.03 / $164.28 / $210.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.03 / $126.56 / $162.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.54 / $155.69 / $232.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.54 / $98.54 / $252.73
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.25 / $126.56 / $162.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.25 / $126.56 / $164.47
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.00 / $249.00 / $249.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.98 / $101.03 / $111.13