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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
$9.13 / $9.13 / $9.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $9.13 / $24.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.57 / $9.67 / $11.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.77 / $9.60 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.79 / $8.66 / $9.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87