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Ohio rates for HCPCS Q4248

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

Facilitymedian $550 · 10th–90th $102$1,6600%20%10th90th$550Professionalmedian $550 · 10th–90th $151$8320%50%10th90th$550$2.0$10.0$50.0$200.0$1.0K$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
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $645.65
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $616.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $602.56 / $1,047.13
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $549.54
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $269.15 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $181.97
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $524.81 / $549.54
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $954.99
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $131.83 / $912.01
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $144.54 / $158.49
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $144.54 / $269.15
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $6,025.60
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $2,818.38