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Utah rates for HCPCS Q4106

Dermagraft, per sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.29 / $37.29 / $37.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.85 / $37.29 / $111.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.94 / $44.94 / $65.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $44.94 / $44.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.34 / $46.28 / $60.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.94 / $50.94 / $50.94