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Nebraska rates for HCPCS Q4248

Dermacyte amniotic membrane allograft, per square centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.20 / $555.20 / $2,824.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.20 / $555.20 / $610.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$534.26 / $628.54 / $628.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$597.11 / $628.53 / $3,197.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.20 / $555.20 / $555.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.20 / $1,410.75 / $4,307.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,079.08 / $3,356.53 / $5,225.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,697.36 / $2,824.50 / $2,824.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,242.46 / $3,356.53 / $4,307.55
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,242.46 / $3,356.53 / $4,307.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$527.44 / $555.20 / $2,109.76