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Nebraska rates for HCPCS Q4214

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $117.49 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $117.49 / $138.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $223.87 / $309.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $147.91 / $181.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $208.93 / $309.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $141.25