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Georgia rates for HCPCS Q4248

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $1,000.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $2,570.40 / $2,570.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $524.81 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $660.69
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $257.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $5,495.41 / $7,762.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $2,691.53 / $2,818.38