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Utah rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.91 / $8.91 / $8.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $26.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.51 / $10.96 / $11.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $7.94 / $7.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.71 / $30.20 / $75.86
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.23 / $131.83 / $162.18
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.41 / $7.41 / $120.23
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.94 / $154.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $125.89 / $125.89