go back

Maryland 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
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $660.69
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,000.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $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
$131.83 / $186.21 / $2,398.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $2,511.89 / $2,818.38
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $173.78 / $204.17