go back

Nebraska rates for HCPCS Q4249

AMNIPLY, for topical use only, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,789.55 / $1,969.89 / $1,969.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,166.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,895.59 / $2,230.11 / $2,230.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,924.64 / $2,118.59 / $2,230.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $4,473.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,789.55 / $2,773.80 / $3,400.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,789.55 / $1,789.55 / $2,702.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$612.51 / $2,147.44 / $2,147.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,147.44 / $2,147.44 / $2,147.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,871.40 / $1,969.89 / $2,403.27