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Alaska rates for HCPCS Q4248

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

Facilitymedian $692 · 10th–90th $178–$4,2660%10%20%10th90th$692Professionalmedian $550 · 10th–90th $240–$1,0000%20%10th90th$550$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
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $977.24
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $575.44 / $1,479.11
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $338.84 / $954.99
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,801.89 / $4,265.80 / $5,888.44
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,691.53 / $2,951.21 / $3,235.94
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $575.44 / $1,479.11
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $1,949.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $125.89 / $446.68