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Dermacyte Amniotic Membrane Allograft

Utah rates for HCPCS Q4248

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

Rates data updated July 2026.

How much does Dermacyte Amniotic Membrane Allograft cost?

$562

Typical negotiated rate. In Utah, July 2026.

Insurers have agreed to pay about $562 for this service. The price depends on where it is billed: about $562 from a physician practice, and about $646 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$562$214 to $617
FacilityA hospital or hospital-owned outpatient department$646$646 to $646

How much rates vary

Facilitymedian $646 · 10th to 90th $447 to $851Professionalmedian $562 · 10th to 90th $126 to $692
$100$200$500$1K$2K$5Kfacility $646professional $562

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$645.65
Median
$645.65
Typical High
$645.65
Aetna
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$616.60
Typical High
$691.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$446.68
Median
$851.14
Typical High
$3,981.07
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$141.25
Typical High
$177.83
Select Health
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$120.23
Select Health
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$120.23
Typical High
$144.54
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$169.82
Typical High
$269.15
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Utah sits

The same service costs 2.7 times more in South Dakota than in Minnesota. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Utah· 5th of 51

$562

SD $692MN $257

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.