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Nebraska rates for HCPCS Q4165

Keramatrix Or Kerasorb Per Square Centimeter (Desc Rvsd 10/1/19)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.59 / $42.59 / $42.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.59 / $42.59 / $45.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.59 / $67.29 / $80.92
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.36 / $44.36 / $136.72
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.00 / $36.00 / $36.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.00 / $36.00 / $36.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.14 / $44.36 / $48.80