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Nebraska rates for HCPCS Q4221

Amnio Wrap2, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $2,157.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,887.04 / $2,220.05 / $2,220.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,109.05 / $2,220.05 / $2,220.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,952.77 / $2,416.80 / $3,101.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,764.90 / $3,235.65 / $3,799.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $2,400.63
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,952.77 / $2,416.80 / $3,101.56
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,952.77 / $2,416.80 / $3,101.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.95 / $1,961.00 / $2,157.10