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Utah rates for HCPCS Q4164

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,903.48 / $1,903.48 / $1,903.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,640.93 / $1,805.02 / $2,051.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$375.34 / $766.49 / $1,952.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,640.93 / $1,640.93 / $1,640.93
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
$1,624.52 / $1,805.02 / $1,805.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,640.93 / $1,640.93 / $1,640.93