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Utah rates for HCPCS A2013

Innovamatrix Fs, Per Sq Cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,344.60 / $1,344.60 / $1,344.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,312.20 / $1,344.60 / $1,393.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,377.00 / $1,377.00 / $1,377.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,377.00 / $1,377.00 / $1,377.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,112.80 / $1,263.19 / $1,454.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,350.00 / $1,350.00 / $1,350.00