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Nebraska rates for HCPCS Q4205

Membrane Graft or Membrane Wrap, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $1,259 · 10th–90th $170$2,2390%10%10th90th$1,259Professionalmedian $1,230 · 10th–90th $1,230$1,4790%50%90th$1,230$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $1,230.27 / $1,230.27
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,230.27 / $1,479.11
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,318.26 / $1,412.54
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,318.26 / $1,318.26 / $1,412.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $208.93 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $1,258.93 / $1,621.81
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $1,479.11 / $2,398.83
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,202.26 / $1,698.24
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,258.93 / $1,348.96 / $1,737.80
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $208.93 / $309.03
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,737.80 / $2,951.21
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $1,288.25 / $2,818.38
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $141.25 / $1,047.13