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Utah rates for HCPCS Q4151

AmnioBand or Guardian, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.47 / $156.47 / $156.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $156.47 / $431.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.01 / $189.42 / $217.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $134.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $111.15 / $138.93
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.53 / $148.37 / $178.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $134.88