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Utah rates for HCPCS Q4102

Oasis Wound Matrix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.79 / $13.79 / $13.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $13.79 / $35.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.99 / $15.95 / $19.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.64 / $14.91 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.76 / $13.07 / $14.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88