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Nebraska rates for HCPCS Q4235

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.48 / $87.98 / $87.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.98 / $87.98 / $96.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.66 / $99.60 / $99.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.56 / $94.62 / $99.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.98 / $87.98 / $87.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.98 / $113.91 / $179.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.48 / $136.82 / $329.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.48 / $80.48 / $94.93
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.47 / $113.91 / $146.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.58 / $113.91 / $201.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.58 / $87.98 / $87.98