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Utah rates for HCPCS Q4100

Skin Substitute, Nos

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.65 / $34.65 / $34.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.65 / $34.65 / $35.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.40 / $125.40 / $125.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $60.00