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Utah rates for HCPCS Q4188

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$565.60 / $565.60 / $565.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $536.34 / $609.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.50 / $526.50 / $704.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $487.59
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
$482.71 / $536.34 / $536.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $487.59