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Nebraska rates for HCPCS J7340

Carbidopa 5 Mg/Levodopa 20 Mg Enteral Suspension 100 Ml (Desc Revised 01/01/2017) Dermal And Epidermal (Substitute) Tissue Of Humanorigin With Or Without Bioengineered Or Processed Elements With Metabolically Active Elements Per Square Centimeter (Del 12/31/08)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.15 / $371.14 / $538.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.61 / $243.61 / $408.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $275.79 / $275.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.21 / $262.00 / $275.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$238.54 / $238.54 / $238.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.23 / $281.88 / $300.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.15 / $261.97 / $1,178.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.26 / $243.15 / $279.18
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$268.98 / $300.22 / $471.90
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.61 / $282.93 / $557.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.44 / $243.61 / $246.95