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Nebraska rates for HCPCS Q4205

Membrane Graft Or Membrane Wrap Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,190.44 / $1,237.28 / $1,237.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,237.28 / $1,237.28 / $1,361.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,190.61 / $1,400.73 / $1,400.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.61 / $1,330.69 / $1,400.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,237.28 / $1,237.28 / $1,237.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,237.28 / $1,335.09 / $1,739.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,190.44 / $1,964.23 / $3,277.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,055.97 / $1,190.44 / $1,679.60
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,267.16 / $1,321.96 / $1,626.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,267.16 / $1,428.53 / $2,012.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,055.97 / $1,237.28 / $1,361.01