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Utah rates for HCPCS Q4110

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

Facilitymedian $76 · 10th–90th $76–$1000%50%90th$76Professionalmedian $68 · 10th–90th $45–$1700%20%10th90th$68$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
$75.86 / $75.86 / $75.86
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $66.07 / $117.49
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $93.33 / $154.88
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 / $51.29 / $75.86
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $131.83 / $162.18
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $67.61 / $120.23
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $144.54 / $245.47
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $125.89 / $125.89