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Utah rates for HCPCS Q4221

Amniowrap2 Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,274.76 / $2,274.76 / $2,274.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $2,157.10 / $2,451.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,961.00 / $2,480.00 / $4,791.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00
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
$1,941.39 / $2,157.10 / $2,157.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00