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Utah rates for HCPCS Q4108

Integra matrix, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $44 · 10th–90th $44$720%50%90th$44Professionalmedian $42 · 10th–90th $38$1700%20%10th90th$42$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $43.65 / $43.65
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $41.69 / $117.49
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$44.67 / $58.88 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $47.86 / $75.86
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $141.25 / $162.18
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $51.29 / $125.89
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $144.54 / $245.47
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $125.89 / $125.89