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Utah rates for HCPCS Q4249

Amniply, per sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,285.07 / $2,285.07 / $2,285.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $2,166.88 / $2,462.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,950.19 / $2,166.88 / $2,166.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89