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Texas rates for HCPCS Q4248

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

Facilitymedian $550 · 10th–90th $6$4,5710%20%10th90th$550Professionalmedian $550 · 10th–90th $126$6460%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 / $562.34
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $616.60
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.75 / $5.75 / $15.14
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.75 / $5.75 / $5.75
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $120.23 / $549.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $316.23 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,943.28 / $7,943.28 / $7,943.28
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10,471.29 / $10,715.19 / $10,715.19
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $549.54 / $1,230.27
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $549.54 / $575.44
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $1,047.13
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,778.28 / $1,778.28 / $1,778.28
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $549.54 / $1,230.27
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $2,691.53 / $4,570.88
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $2,818.38
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $125.89 / $125.89