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Utah rates for HCPCS Q4101

Apligraf Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.07 / $35.07 / $35.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $35.07 / $105.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.36 / $40.25 / $46.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.62 / $30.00 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.93 / $33.25 / $43.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23