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Utah rates for HCPCS Q4139

Amniomatrix Or Biodmatrix Injectable 1 Cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,820.00 / $1,820.00 / $1,820.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.00 / $987.52 / $1,820.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $60.00