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Utah rates for HCPCS Q4170

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.60 / $45.60 / $45.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.31 / $43.24 / $49.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.31 / $518.16 / $1,058.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.31 / $39.31 / $39.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.92 / $43.24 / $175.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.31 / $39.31 / $39.31