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Nebraska rates for HCPCS Q4256

MLG-Complete, 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 / $741.31 / $741.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $891.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $831.76 / $4,265.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $794.33 / $831.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $223.87 / $309.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $954.99 / $1,445.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $1,174.90 / $1,621.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,230.27
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,122.02 / $1,445.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $208.93 / $309.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,445.44 / $2,041.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $1,548.82 / $2,454.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $933.25 / $1,862.09