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North Carolina rates for HCPCS Q4253

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

Facilitymedian $209 · 10th–90th $76–$1,1480%10%10th90th$209Professionalmedian $79 · 10th–90th $76–$6170%20%40%10th90th$79$1.0$5.0$20.0$100.0$500.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$616.60 / $616.60 / $616.60
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $616.60
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $131.83 / $208.93
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $89.13 / $95.50
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $190.55 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $169.82
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $467.74 / $1,148.15
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $109.65 / $316.23
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $194.98 / $245.47
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $117.49 / $131.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $125.89 / $134.90
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,148.15 / $1,148.15 / $1,148.15
Wellcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,318.26 / $1,318.26 / $1,318.26