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Utah rates for HCPCS Q4141

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.08 / $124.08 / $124.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.97 / $117.66 / $133.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.43 / $54.04 / $90.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.97 / $106.97 / $106.97
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
$105.89 / $117.66 / $117.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.97 / $106.97 / $106.97