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AmnioArmor

Utah rates for HCPCS Q4188

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

Rates data updated October 2026.

How much does AmnioArmor cost?

$126

Typical negotiated rate. In Utah, October 2026.

Insurers have agreed to pay about $126 for this service. The price depends on where it is billed: about $126 from a physician practice, and about $575 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$126$126 to $145
FacilityA hospital or hospital-owned outpatient department$575$562 to $724

How much rates vary

Facilitymedian $575 · 10th to 90th $562 to $741Professionalmedian $126 · 10th to 90th $123 to $562
$50$100$200$500$1Kfacility $575professional $126

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$562.34
Median
$562.34
Typical High
$562.34
Aetna
Setting
Professional
Modifier
None
Typical Low
$537.03
Median
$562.34
Typical High
$562.34
Cigna
Setting
Facility
Modifier
None
Typical Low
$575.44
Median
$645.65
Typical High
$741.31
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Molina
Setting
Professional
Modifier
None
Typical Low
$30.20
Median
$44.67
Typical High
$60.26
Regence BlueShield
Setting
Professional
Modifier
None
Typical Low
$123.03
Median
$131.83
Typical High
$151.36
Select Health
Setting
Facility
Modifier
None
Typical Low
$120.23
Median
$120.23
Typical High
$120.23
Select Health
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$120.23
Typical High
$154.88
U of Utah Health Plan
Setting
Professional
Modifier
None
Typical Low
$83.18
Median
$169.82
Typical High
$295.12
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
4 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$269.15
Median
$281.84
Typical High
$281.84
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$107.15
Median
$112.20
Typical High
$112.20
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$81.28
Median
$85.11
Typical High
$85.11
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$53.70
Median
$56.23
Typical High
$56.23

Where Utah sits

The same service costs 7.1 times more in Wyoming than in North Carolina. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Utah· 46th of 51

$126

WY $832NC $117

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.