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Nebraska rates for HCPCS Q4201

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.09 / $76.09 / $79.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.09 / $83.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.22 / $86.14 / $86.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.81 / $86.14 / $89.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.09 / $76.09 / $76.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $103.62 / $132.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.23 / $130.72 / $233.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.23 / $79.23 / $333.68
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.94 / $103.62 / $132.97
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.07 / $103.62 / $143.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.53 / $91.53 / $142.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.29 / $76.09 / $114.14