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Nebraska rates for HCPCS Q4197

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.70 / $70.70 / $71.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $77.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.03 / $80.04 / $80.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.04 / $80.04 / $80.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $88.24 / $113.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.04 / $120.77 / $275.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.04 / $71.04 / $303.64
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.81 / $88.24 / $113.24
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.81 / $88.24 / $169.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.17 / $70.70 / $106.05