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AMNIOREPAIR or AltiPly

Utah rates for HCPCS Q4235

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

Rates data updated July 2026.

Facilitymedian $102 · 10th–90th $102$1350%50%90th$102Professionalmedian $98 · 10th–90th $87$1620%20%10th90th$98$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$102.33
Aetna
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$95.50
Typical High
$109.65
Cigna
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$134.90
Typical High
$223.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$141.25
Typical High
$177.83
Select Health
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$120.23
Select Health
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$120.23
Typical High
$144.54
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$169.82
Typical High
$269.15
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89