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Nebraska rates for HCPCS Q4259

Celera Dual Layer or Celera Dual Membrane, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$713.50 / $713.50 / $941.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $784.85
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$726.98 / $807.75 / $3,549.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$767.36 / $807.75 / $1,065.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$713.50 / $713.50 / $713.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $1,460.04 / $1,921.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$941.46 / $1,487.51 / $2,234.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$941.46 / $941.46 / $1,460.98
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,129.75 / $1,170.31 / $1,664.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,129.75 / $1,252.70 / $1,921.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,033.78 / $1,033.78 / $1,609.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$677.83 / $713.50 / $1,070.25