HCPCS Q4289
Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Revoshield+ amnio, per sq cm
Low
$66
Average
$195
Median
$161
High
$445
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
20 payers; the 90th percentile is 2.5× the 10th. Each bar is a price range and its height is how many payers fall in it. Hover a bar, or a row in the ladder, for details.
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| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | UnitedHealthcare facility · case rate · outpatient · +2 other terms | 17 | $130 | $213 | $283 | 133% | — | $49 – $1.4k |
| 2 | Aetna facility · case rate · outpatient · +2 other terms | 13 | $131 | $549 | $1.2k | 211% | — | $119 – $3.8k |
| 3 | Blue Cross Blue Shield case rate · outpatient · +1 other terms | 11 | $125 | $17 | $26 | 159% | — | $5 – $133 |
| 4 | Humana facility · case rate · outpatient · +1 other terms | 11 | $127 | $131 | $9 | 7% | — | $124 – $160 |
| 5 | WellCare case rate · outpatient · +1 other terms | 10 | $133 | $134 | $2 | 2% | — | $131 – $138 |
| 6 | Molina case rate · outpatient · +1 other terms | 9 | $133 | $133 | $1 | 1% | — | $131 – $133 |
| 7 | Ambetter facility · case rate · outpatient | 4 | $153 | $185 | $57 | 31% | — | $150 – $284 |
| 8 | Anthem facility · case rate · outpatient | 4 | $249 | $257 | $135 | 52% | — | $49 – $501 |
| 9 | Caresource facility · case rate · outpatient | 4 | $254 | $172 | $101 | 59% | — | $49 – $254 |
| 10 | Devoted facility · case rate · outpatient | 4 | $131 | $132 | $4 | 3% | — | $127 – $137 |
← Hospitals reporting HCPCS Q4289 · Snapshot 20261113T090226Z-3ce6c0b8