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Utah rates for HCPCS Q4121

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.19 / $61.19 / $61.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $61.19 / $135.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.68 / $63.99 / $73.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $52.75 / $52.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.78 / $50.04 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.33 / $56.13 / $58.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $52.75 / $52.75