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Utah rates for HCPCS Q4247

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,054.40 / $3,054.40 / $3,054.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,980.80 / $3,054.40 / $3,164.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$775.00 / $775.00 / $3,128.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,128.00 / $3,128.00 / $3,128.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,200.00 / $3,200.00 / $3,200.00