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Utah rates for HCPCS Q4115

Alloskin Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.92 / $14.92 / $14.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $14.15 / $16.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.42 / $17.73 / $23.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $12.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.89 / $9.71 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.03 / $14.15 / $14.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $12.86