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Utah rates for HCPCS Q4248

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

Facilitymedian $646 · 10th–90th $646–$3,2360%50%90th$646Professionalmedian $562 · 10th–90th $126–$1,0000%20%10th90th$562$50.0$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $645.65 / $645.65
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $575.44 / $1,000.00
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $741.31 / $3,981.07
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $30.20
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $141.25 / $177.83
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $120.23 / $125.89
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $169.82 / $269.15
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89