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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
$43.65 / $43.65 / $43.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $38.90 / $109.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.48 / $67.61 / $72.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $38.90 / $38.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $47.86 / $75.86
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $144.54 / $162.18
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $51.29 / $125.89
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $38.90 / $144.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $125.89 / $125.89