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Utah rates for HCPCS Q4138

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $100.00 / $199.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $134.90 / $141.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $97.72 / $97.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $44.67 / $234.42
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $144.54 / $162.18
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $120.23 / $251.19
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $97.72 / $154.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $234.42