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Utah rates for HCPCS Q4154

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $151.36 / $151.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $131.83 / $162.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $190.55 / $218.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $131.83 / $131.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $60.26 / $398.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $144.54 / $169.82
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $120.23 / $380.19
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $131.83 / $177.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $371.54