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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
$2,901.66 / $2,979.56 / $2,979.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $3,277.51
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,867.18 / $3,373.15 / $3,373.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,120.71 / $3,284.96 / $3,373.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,979.55 / $2,979.55 / $2,979.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.55 / $3,435.76 / $7,254.14
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,901.66 / $4,642.66 / $5,513.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,855.38 / $2,901.66 / $2,901.66
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,435.76 / $3,435.76 / $4,409.22
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,435.76 / $3,481.99 / $4,409.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,830.58 / $2,979.56 / $2,979.56