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Utah rates for HCPCS Q4225

AmnioBind or DermaBind TL, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $1,659.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $1,412.54 / $1,659.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,995.26 / $2,238.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,412.54 / $1,412.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $60.26 / $60.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $144.54 / $162.18
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $120.23 / $125.89
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $1,412.54 / $1,698.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $1,445.44