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Montana rates for HCPCS Q4248

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

Facilitymedian $1,148 · 10th–90th $166$3,1620%20%10th90th$1,148Professionalmedian $550 · 10th–90th $141$1,1480%20%40%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 / $691.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $3,162.28 / $3,162.28
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $181.97 / $3,162.28
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $1,148.15 / $2,089.30
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $1,148.15 / $2,089.30
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $616.60 / $3,162.28
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $125.89 / $3,162.28
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89