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Utah rates for HCPCS Q4128

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.70 / $34.70 / $34.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $32.90 / $37.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.91 / $40.40 / $46.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $29.91
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.61 / $32.90 / $32.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $29.91