go back

Nebraska rates for HCPCS Q4253

Zenith Amniotic Membrane, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.79 / $75.79 / $83.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $83.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.93 / $85.80 / $85.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.51 / $85.79 / $94.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.79 / $75.79 / $75.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $110.11 / $304.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $141.41 / $1,054.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.50 / $83.18 / $1,142.97
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.80 / $99.81 / $179.14
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.80 / $110.11 / $647.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.00 / $75.79 / $113.69