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Nebraska rates for HCPCS Q4247

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,944.00 / $2,944.00 / $2,944.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,944.00 / $2,944.00 / $3,128.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$510.01 / $600.01 / $600.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$570.00 / $600.00 / $600.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,128.00 / $3,128.00 / $3,128.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$610.24 / $715.50 / $3,128.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.00 / $1,384.03 / $2,534.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,240.00 / $3,200.00 / $3,677.25
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$610.24 / $715.50 / $1,356.80
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$610.24 / $666.24 / $1,356.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,040.00 / $3,200.00 / $3,520.00