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Virginia rates for HCPCS Q4248

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

Facilitymedian $417 · 10th–90th $132$1,7780%20%10th90th$417Professionalmedian $562 · 10th–90th $132$2,6920%50%10th90th$562$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 / $575.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $2,691.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,137.96 / $2,137.96 / $3,801.89
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,000.00 / $4,365.16
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $251.19 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $173.78 / $2,398.83
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $588.84 / $1,995.26
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $549.54 / $1,000.00
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $173.78 / $1,862.09
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $173.78 / $1,862.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,454.71 / $4,570.88 / $6,025.60
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $2,818.38