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Utah rates for HCPCS Q4114

Integra flowable wound matrix, injectable, 1 cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $2,344.23 / $2,344.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,344.23 / $3,019.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $2,137.96 / $2,454.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,479.11 / $1,479.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $75.86 / $2,187.76
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $120.23 / $2,398.83
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,479.11 / $1,778.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $2,818.38 / $2,818.38