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Nebraska rates for HCPCS Q4199

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.15 / $111.15 / $130.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $122.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.96 / $125.84 / $125.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.55 / $125.84 / $147.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.15 / $111.15 / $111.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $398.91 / $511.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.26 / $221.44 / $711.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.26 / $130.26 / $332.42
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.98 / $398.91 / $511.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.31 / $398.91 / $545.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.59 / $111.15 / $122.27