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Utah rates for HCPCS Q4147

Architect, Architect PX, or Architect FX, extracellular matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.42 / $47.42 / $47.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.28 / $47.42 / $49.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.56 / $48.56 / $215.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.56 / $48.56 / $48.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $64.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.13 / $57.13 / $57.13