go back

Utah rates for HCPCS Q4108

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.71 / $44.71 / $44.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $42.40 / $48.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.45 / $59.22 / $72.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $38.54 / $38.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.71 / $47.77 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.15 / $42.40 / $42.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $38.54 / $38.54