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Utah rates for HCPCS Q4117

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.81 / $23.81 / $23.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.24 / $23.81 / $24.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $121.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $28.69 / $28.69