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Utah rates for HCPCS Q4156

Neox 100 Or Clarix 100 Per Square Centimeter (Desc Revised 1/1/2018)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.42 / $76.42 / $76.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.88 / $72.47 / $82.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.92 / $84.59 / $97.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.88 / $65.88 / $65.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $183.49
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.22 / $72.47 / $72.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.88 / $65.88 / $65.88