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Utah rates for HCPCS Q4253

Zenith Amniotic Membrane Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.92 / $87.92 / $87.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $83.37 / $94.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.30 / $157.74 / $181.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $75.79
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
$75.03 / $83.37 / $83.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $75.79