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Utah rates for HCPCS Q4103

Oasis Burn Matrix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.49 / $14.49 / $14.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $13.74 / $15.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.59 / $16.48 / $18.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.92 / $2.10 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.37 / $13.74 / $13.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49