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Nevada rates for HCPCS Q4205

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,190.44 / $1,190.44 / $1,348.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,237.28 / $1,237.28 / $1,361.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.56 / $336.60 / $336.60
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 / $1,237.28 / $1,237.28
Hometown Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.61 / $1,342.34 / $1,680.00
Hometown Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.38 / $127.38 / $127.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,237.28 / $1,237.28 / $1,237.28