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Nebraska rates for HCPCS Q4219

Surgigraft-Dual Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$960.00 / $960.00 / $960.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$960.00 / $960.00 / $1,020.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$960.00 / $1,440.00 / $1,824.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$788.99 / $788.99 / $812.66
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$749.54 / $788.99 / $788.99