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Maryland rates for HCPCS Q4253

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

Facilitymedian $1,148 · 10th–90th $1,148–$1,1480%50%100%$1,148Professionalmedian $76 · 10th–90th $76–$1260%50%90th$76$50.0$100.0$200.0$500.0$1.0K$2.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $95.50
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$31.62 / $31.62 / $31.62
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
$131.83 / $186.21 / $1,023.29
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,148.15 / $1,148.15 / $1,148.15
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $125.89 / $141.25
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $181.97 / $204.17