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Nebraska rates for HCPCS Q4250

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $2,951.21 / $2,951.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $2,951.21 / $3,467.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $3,235.94 / $3,388.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,162.28 / $3,235.94 / $3,388.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $223.87 / $309.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $2,951.21 / $3,467.37
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $3,467.37 / $5,623.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.03 / $2,884.03 / $3,467.37
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,467.37 / $3,467.37 / $4,365.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $208.93 / $309.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,365.16 / $7,244.36 / $7,244.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $4,677.35 / $7,585.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $2,818.38 / $2,884.03