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Wisconsin rates for HCPCS Q4248

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

Facilitymedian $2,399 · 10th–90th $550$4,4670%20%10th90th$2,399Professionalmedian $550 · 10th–90th $155$1,0960%50%10th90th$550$5.0$20.0$100.0$500.0$2.0K$10.0K

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
$575.44 / $575.44 / $575.44
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
$154.88 / $213.80 / $549.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $2,290.87 / $3,981.07
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $223.87 / $1,412.54
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $575.44 / $1,258.93
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,818.38 / $2,884.03 / $4,466.84
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,818.38 / $2,818.38 / $5,888.44
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $60.26 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,148.15 / $1,148.15 / $1,148.15
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $269.15 / $446.68
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $2,818.38 / $8,128.31
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $575.44 / $10,471.29
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $741.31 / $912.01
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,818.38 / $2,818.38 / $6,606.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $2,818.38